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Clinician Referral forms

Clinician Referral Form

Please fill out this form to refer a patient to White Light Prosthodontics.

For patients wanting to enquire without a referral, please fill out the form. We welcome patients with or without official referrals.

Patient Details

Referral Details

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New Patient Documents

Please fill out the new patient form online to save time before your first appointment.

Click to download our new patients form

Self Refer

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Why Choose
White Light Prosthodontics

  1. Experienced Specialist Team: Highly trained specialists with extensive experience in prosthodontics.
  2. State-of-the-Art Practice: Utilising the latest technology and cutting-edge techniques for advanced treatments.
  3. Convenient CBD Location in Melbourne: Easily accessible clinic in the heart of Melbourne.

Send Your Selfie
Show Us Your Smile

Please contact us via this website or email without disclosing confidential information.

Send us your smile photos with a description of what you're hoping to achieve and you can start to discuss your smile plan before you arrive at the clinic. Dr Kenny Chong has seen it all before, let's make you an appointment.

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YOUR PHOTO
Send Your Selfie
  • Nervous about coming in to see us?
  • Don't want to travel just yet?
  • Considering your options?
  • Short on time?
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