Your Medical and Dental History

As a new patient we need to get to know you and your medical and dental history so that we can gain a comprehensive understanding of your current and past oral health to provide you with the highest quality treatment.

For this reason we will request that you complete a New Patient Form. This can be done in just a few minutes at our practice, prior to your appointment.

However, for your convenience, we have also made this form available online (see below), so the answers will be sent straight to our practice.

Alternatively, you can download the form to complete at a time that suits you.

Please be assured that this information is maintained in accordance with State and Federal Privacy Legislation.

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)

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