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Player’s Date of Birth:
Are you a previous patient of Whitesmile Dental Care?


Private Health Insurance
Please select your payment option from the following

Payment Details

Cost for players with no Health Fund $80 plus GST
Players with Health Fund no out of pocket cost: item numbers billed 013 151.
In the event that your Health Fund does not cover the $80 plus GST players will need to pay the difference.

Whitesmile Dental Care’s Bank Details:
BSB: 064 183
Account Number: 1036 8255
Account Name: Cameron Christophers
Reference: Player’s Full Name
Email transaction receipt to: [email protected]