Online Referral Online Referral Address 57 Harold Street, Hawthorn East, VIC 3123 (03) 9813 1866 (03) 9813 1888 reception@pdisc.com.au Working Hours Monday 8.30 – 17.00 Tuesday 8.30 – 17.00 Wednesday 8.30 – 17.00 Thursday 8.30 – 17.00 Friday 8.30 – 16.00 Please enable JavaScript in your browser to complete this form.Referring Clinician's InformationReferring Clinician *FirstLastAddress *Address Line 1CityState / Province / RegionPostal CodePhone *Email *Referring toDr. William ZhangDr. Elizabeth YuDr. Belinda HasegawaPatient InformationPatient Name *FirstLastAddress *Address Line 1CityState / Province / RegionPostal CodeDate of Birth *Phone *Email *Reason for referralPeriodontal Disease Assessment & ManagementImplant TherapyCrown Lengthening SurgeryRecession or Mucogingival ConcernSurgical ManagementOther TreatmentFurther detailsRadiology includedYesNoRadiology Upload Click or drag a file to this area to upload. Submit
