Make an appointment

Make an appointment with your dentist

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Personal details

Date of Birth
Do you have a private health fund with dental cover ?

Guardian details (if patient is under 18 years of age)

Language and background

Are you of Aboriginal or Torres Strait Islander
Is English your preferred language?

Question

Are you currently receiving treatment from a doctor?

List details (if applicable)

Known allergies (e.g., medications, penicillin, latex)
Previous reaction to local or general anaesthesia?
Are you currently pregnant? If yes, How many weeks
Do you smoke or vape?
Do you use any recreational drugs or other substances?
Have you been advised that you need antibiotic coverage prior to receiving dental care?
Do you use any mobility aids (eg. wheelchair, walker, cane)?
Do you have any dental fears or anxiety?
Have you had any hospital stays, surgeries, procedures in the last 12 months?

Please see back for more details