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Level 3, Suite 301, 10 Help Street, Chatswood NSW 2067 T: 02 9411 3003 F: 02 9411 1006Level 3, Suite 21, 27 Hunter Street, Parramatta NSW 2150 T: 02 9891 1610 F: 02 9891 1831Level 1, Kiaora Place, 451 New South Head Rd, Double Bay NSW 2028 T: 02 9326 1399 F: 02 9411 1006
Date / /
Email address:
TREATMENT: Consultation/Prognosis Endodontic Treatment Diagnosis of Pain Endodontic Re-treatment Post Removal Intravenous Sedation Cracked Tooth
TOOTH:
POST SPACE REQUIRED?Yes No
CORE RESTORATION REQUIRED?Yes No
NOTES:
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Trauma Management Periapical Surgery Perforation Repair Non-Vital Bleaching Internal/External Resorption
Other:
SPECIALIST ENDODONTIST
Dr Mark JohnstoneDental Specialist - Endodontist BDSc(Hons), DClinDent, MHth&MedLaw
Dr Mehdi RahimiDental Specialist - EndodontistAdjunct Associate Professor (CSU)BSc, BDS Distinction (NZ)DClinDent (Melb), FICD, FPFA, MRACDS
Referred by Dr:
Address:
Phone:
Dr Martin M Habibi
First Available Specialist Endodontist
Dr Garima SharmaDental Specialist - EndodontistBDS, DClinDent (Adelaide)
Dr Chankhrit SathornDental Specialist - EndodontistAdjunct Professor (CSU)DDS, GradDipClinDent, DClinDent, PhD (Melb), MRACDS (Endo)
Dental Specialist - EndodontistDDS, DClinDent (UWA)MRACDS (Endo)
Dr Langley Tasmania Dental Specialist - EndodontistBDS (Fiji), DClinDent (Otago)
CHATSWOODLevel 3, Suite 301, 10 Help St,Chatswood NSW 2067T: 02 9411 3003F: 02 9411 3006
PARRAMATTALevel 3, Suite 21, 27 Hunter Street,Parramatta NSW 2150(Entry via O’Connell Street)T: 02 9891 1610F: 02 9891 1831
DOUBLE BAYLevel 1, Kiaora Place,451 New South Head Road,Double Bay NSW 2028T: 02 9326 1399F: 02 9411 3006
New South Head RoadKiaora Ln
Knox St
Short St
Gum
Tre
e Ln
Bay
St
Manning Rd
WEARE
HERE
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