Request an Appointment

Please fill out the online form below or give us a call at (02) 4628 3377 to request an appointment with our specialist. We look forward to seeing you at Macarthur Surgical Centre.
Have you been to Macarthur Surgical Centre previously?*

YesNo
Patient Information
Name*

PrefixFirst NameLast Name
Date of birth*

DayMonthYear
Contact Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

SuburbState

Postcode
Email*
Referring Doctor Information
Dr*

First NameLast Name
Clinic or practice name*
Postcode*
Have you received a referral letter from your dentist or medical professional?*

Yes, I have a hard copyThe practitioner will or have submit the referral onlineNo
Please take a photo of your referral letter
Reason for Your Visit
Were you referred to any specific specialist?*

Dr Jasvir Singh (Oral & Maxillofacial Surgeon)Dr Pasquale Mollica (Oral & Maxillofacial Surgeon)Dr Suma Sukumar (Oral Medicine Specialist)No, but I would like to see the next available specialist
Select the option that best describes your reason for visit*

Removal of Wisdom TeethSurgical Tooth RemovalDental ImplantAll-on-4®Corrective Jaw SurgeryConsultation for Lesion or UlcerOther
Have you had any CBCT or OPG x-ray taken in the past year?*

Yes, I have bothYes, I have OPG x-rayYes, I have CBCT 3D scanNo, I have neither
If it is possible, please take a picture of the area of concern with your mobile phone camera to be used as a reference prior to your appointment.
Where did you have it done?

At the DentistLUMUS lmagingI-MED RadiologySpectrum Medical ImagingPRP Diagnostic ImagingOther
It is paramount to have a CBCT or OPG x-ray for diagnosis purposes during your consultation. Do you need help providing a radiography record or clinical photo prior to your appointment?
Appointment Time Preferences

We will try to accommodate your preferences, though the appointment is subject to our specialists' availability.
Select your preferred days

MondayTuesdayWednesdayThursdayFriday (for Oral Medicine Consultation ONLY)
Select your preferred timing

Please fill out the online form below or give us a call at (02) 4628 3377 to request an appointment with our specialist. We look forward to seeing you at Macarthur Surgical Centre.

Patient Information

Referring Doctor Information

Reason for Your Visit

Appointment Time Preferences