Referral form


Making a referral to Bee Healthy Regional Dental Service

If a child has had an accident and has an injury to their teeth or mouth, please advise the parent to contact a private practice dentist to book a dental exam and register the injury with ACC. Some dentist may charge a ACC co-payment, so they will need to check this when booking. Bee Healthy is not an ACC provider so is unable to provide care for injury-related dental issues.

If the child is in pain, please call 0800 825 583 (0800 TALK TEETH) directly to make a relief of pain appointment.

Please complete the referral form below if you see any of the following on a child's teeth:

  • chalky white spots/patches
  • yellow, brown or black discolouration
  • clearly visible cavities (holes)
  • red inflamed gums
  • abscess on the gum.

Child's details

Has the child had a dental appointment with Bee Healthy before?

Please complete the online enrolment form before the completing referral form.

Enrol online

Parent or guardian contact details

Referral information

Referrer's contact details