Order Number Please tell us who you are and how we can reach you. First Name * Last Name * Email Address * Contact Phone Number Send an SMS? If checked we will send you an SMS (text message) with your appointment information. SMS (text) charges may apply. Contact Information:Dr Virginia WilliamsAddress:4 Raglan Street NorthBallarat, VIC 3350AustraliaEmail: admin@ballaratdentist.com.auPhone: (03) 5331 9285
