Confidential Patient Questionnaire

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This provides the dentist with important information required for your Dental treatment and Oral Health Care

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  • Emergency Contact
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  • *Please note we are not affiliated with "Dentcare"
  • Medical History
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Payment Details

We only accept cash, EFTPOS or Credit card. Cheques will not be accepted unless it is a bank cheque arranged prior to your appointment.

Please note: Terms are strictly payment on the day, thankyou

If costs today are in excess of $400 you will be advised prior to treatment. Please inquire about fees and charges for general dental procedures at the front desk.

Alternatively, new patients can also download the file below. Print it, fill it out and please bring them in with you when you come for your first visit.

Go to a New Patient Consultation form