Clinical Referral Form Submission

Click to download the Referral Form

All Referrals are handled through our Referral Ticket Portal (Image to the right)

You can use this portal to check on your previously submitted referrals and submit new patients easily. To submit a new referral simply click [+Ticket] and attach your completed patient referral form.

To review your previously submitted referrals, click on the [Receive Link], and an access link will be sent to your email address. This will last for 24 hours and is entirely secure.

Please use the downloadable form [Click here to download] to complete your referral, or alternatively, upload your own referral form. Once submitted, you will receive a confirmation email to your chosen email address. Please retain a copy of your form for your records.
If you have any technical issues with this system, please contact drntint@gmail.com