Refer a child (Lift the Lip) Breadcrumb Home Health Topics Dental Health Dental Health Information and Education For Health Professionals Referral To Oral Health Services Refer a Child To Oral Health Services 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. Health or Education Professional use only This form is for referring children to Oral Health Services Tasmania that you have assessed as needing priority dental care. Children must be under 18 years of age. Children must be covered by a current Medicare Card. Feedback will be provided to the referring professional on receipt of referral and completion of care. 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. Referral information Referral Type - None -Child Health and Parenting Service (CHaPS)Early Years EducatorSchool NurseConnected BeginningsOther Health ProfessionalRAHAC – Refugee Health Name of Referrer Email of Referrer Name of School If you have selected school nurse, which school does the child attend? Refugee Health (RAHAC) If you have selected Refugee Health (RAHAC), please provide the caseworker name and contact Oral health assessment: Cavitated lesions (holes) Early-stage decay (white spot demineralisation) Family support for oral health Pain, infection or trauma If your referral is urgent, please call 1300 011 013 Comments Enter Comments Patient information Which region of Tasmania does the patient live in? North North West South Parent/Guardian Full Name Parent/Guardian Telephone Does the patient have a medicare card? Yes No Child's Full Name Child's Date of Birth I give consent to share this information with Oral Health Services Tasmania and to be contacted by them to make an appointment for my child. Patient Address Address Suburb Postcode Does the patient need an interpreter? Yes No What language?