Request an appointment for Dental health service for babies, children and teens

Request an appointment

This form can be used to make a dental appointment with an Oral Health Services Tasmania Dental Clinic or a Telehealth appointment.

We will aim to contact you by the next business day. You will receive a call from us in normal business hours. If you are not available to answer our call we will leave a voice message, if possible.

For any other enquiries please phone Oral Health Services Tasmania on 1300 011 013.

Confidentiality Note: The use of your personal information is subject to the provisions of the Personal Information Protection Act 2004.

Patient information

Parent/Guardian Full Name

Parent/Guardian Telephone

Does the patient have a medicare card?

Yes

Child's Full Name

Child's Date of Birth

Type of Appointment

Which region of Tasmania do you live in?

North

North West

South

Suburb

Does the patient need an interpreter?

Yes

What language?

tas.gov.au

Emergency Contacts

Request an appointment for Dental health service for babies, children and teens