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Medical history form

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Before your visit

Completing this ahead of time means more of your appointment is spent on you, not paperwork. It takes about five minutes.

  • Your answers help us care for you safely and comfortably.
  • Everything you share is confidential, and protected under the Australian Privacy Principles.
  • Not sure about something? Leave it and we will go through it together at your visit.

Section 1

About you

The basics, so we know who we are caring for and how to reach you.

We'll never share your email with anyone else.

Section 2

Medical history

It is important for the dentist to know your medical history, as it can affect how we treat you safely. Everything here is confidential.

I have confidential medical information I would prefer to discuss with the dentist rather than write down.
Are you receiving any medical treatment at present?
Have you been hospitalised in the last 12 months?
Have you had any abnormal reactions to local or general anaesthesia?
Do you require antibiotic cover before dental treatment?
Do you take any blood thinners?
Do you smoke?
Are you pregnant?

Section 3

Existing conditions

Do you have, or have you ever had, any of the following? Tick any that apply.

Section 4

Dental history

So we can pick up where your care left off.

If you feel anxious, telling us means we can take extra care to make you comfortable.

Section 5

How did you hear about us?

It helps us know what is working, and who to thank.

Section 6

Almost done

Please read and confirm, then send your form to our team.

Thank you

Your medical history is on its way to our team. We will have it ready for your first visit.

If anything changes before you come in, you are welcome to fill it in again.

Back to home

For all crowns, veneers, and bridges we exclusively use Australian Prosthetic
Laboratories, so your treatment meets strict Australian quality standards.

Not sure where to start?

Tell us what is on your mind and we will guide you to the right care.
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Your first visit guide