Dentist referrals

Name: Torque Orthodontics
Telephone: (07) 4951 4100

At Torque Orthodontics, we welcome all new patients to our clinic. If you have a patient in need of orthodontic care, you can refer them to us for treatment by filling out the form below. You can rest assured that your patient will be in good hands with our expert care.

Dentist Details

Name

Practice Name

Practice Address

Practice Postcode

Practice Phone *

Patient's details

First Name*

Last Name*

Patient DOB

Parent/guardian Name

Address

Daytime Telephone *

Mobile Number

Oral Condition

Reason for referral

For further information about how we use your data, please see our privacy policy.

Visit us

Visit our beautiful, new office across from Sydney Street Markets in Mackay. We look forward to welcoming you with a smile!

Contact

1/33 Brisbane Street,
Mackay, QLD 4740

(07) 4951 4100

info@torqueortho.com.au

Monday - Thursday: 8:00am to 5:00pm
Friday: 8:00am to 2:30pm

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