• 03 9557 0957
  • Opening Hours
    • Mon - Wed: 9.00-17.00
    • Thursday: 9.00 - 19.00
    • Friday: 9.00-17.00
    • Saturday: 8.00 - 13.00
    • Sunday: Closed

Your Medical and Dental History

To provide safe, personalised dental care, we ask all new patients to complete a Medical & Dental History Form before their first appointment.

The information you provide helps us understand your current health, previous dental treatment, medications, and any factors that may affect your care.

For your convenience, you can:

  • Complete the online form below and submit it directly to our practice or
  • Download the form and complete it at a time that suits you or
  • Complete the form at our clinic before your appointment
Patient Information
Vet Affairs (if applicable)
Emergency Contact
Reminder System

We remind our patients of their appointments. If you would like us to do this please indicate the preferred means of contact.

Please tick any dental concerns you have
Medical History

Have you had or are you suffering from any of these? (please tick)

All information is treated as strictly confidential and managed in accordance with State and Federal Privacy Legislation.