DATE OF BIRTH
PURPOSE OF REFERRAL
Advice and necessary treatment
Please discuss with patient alternative treatments
DR DAVID MASTROIANNI
BDS (SYD), DCD (MELB),
MY ORTHO PTY LTD
143 ALISON RD
RANDWICK NSW 2031
P (02) 9399 7997
F (02) 9399 9442
During the examination appointment I will discuss your orthodontic problems then determine whether or not correction is required, when it would be best to begin, the type of appliance, the time required for treatment, and outline the fees. My staff and I will be glad to assist you with financial arrangements.
Your appointment time is reserved especially for you. Parents or guardians should accompany children and adolescents to this visit.
Please note that bite wing radiographs and regular fluoridation and cleanings are desirable for all patients who are to undergo orthodontic treatment. These are performed by your general dentist.
A map, with our office location highlighted, is on the reverse side.