Complete the form below or download this PDF and bring into our clinic.

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Personal Details
Medical Questionnaire
Please tick if yes
Declaration

Although rare, accidental injury to your dentist and staff can occur from the handling of sharp instruments. If this happens during the course of your treatment, our practice requires both the patient and staff member to undertake a blood test.

I understand that payment is required at the time of treatment / consultation. Missed appointments, late attendance or cancellation with less than 4 hours notice will incur a fee of $85 per 30 minutes of scheduled time.

As a health service provider, The Dental Centre is obligated to treat you in a manner compliant with the Health & Disability Commissioner’s Code of Rights. These can be made available to you upon request.

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