Refer a pregnant woman (Healthy Smiles for Two) Breadcrumb Home Health Topics Dental Health Dental Health Information and Education For Health Professionals Referral To Oral Health Services Healthy Smiles For Two - Referring a Pregnant Woman Listen Print Main navigation Dental health Learn about dental health Dental Health Services Dental health programs and initiatives Dental health information and education for health professionals Referral to dental health services Refer a child (Lift the Lip) Refer a pregnant woman (Healthy Smiles for Two) Referral to Oral Health Services Tasmania for dental services Lift the lip screening and referral pathway tool Tasmania denture care scheme Emergency Dental Scheme Regulation, policy and guidelines for dental health You must have JavaScript enabled to use this form. If you are pregnant, you can have a priority dental appointment with Oral Health Services Tasmania if you: have a current Health Care Card or Pensioner Concession Card (primary cardholder) or are under 18 year of age For any other enquiries please phone 1300 011 013. Confidentiality Note: The use of your personal information is subject to the provisions of the Personal Information Protection Act 2004. Payment detailsA co-payment fee of $45 will apply per appointment - Centrepay can be arranged.If you are under 18, you will be bulk billed - please bring your Medicare Card. Referral information Which region of Tasmania does the patient live in? North North West South Referral Type - Select -MidwifeGPSelf Name of Referrer Email Patient information First Name Last Name Does the patient have a medicare card? Yes No Date of Birth Expected due date Patient's Telephone Address Address Suburb Postcode Does the patient have any concession cards (please select all that apply) Health Care Card Pensioner Concession Card Does the patient need an interpreter? Yes No What language?