Patient Registration & Medical History
Welcome! Please take a few minutes to complete this form before your appointment. Your information helps us provide you with the safest, most personalised care possible. Everything you share is strictly confidential.
Section 1 — Personal Information
Section 2 — Medical History
Please tick any conditions that apply to you:
Current medications (list all, including supplements):
Do you have any known allergies? Tick all that apply:
Please describe your allergies and any reactions you have experienced:
Section 4 — Your Dental Background
When was your last dental visit?
What's the main reason for your visit today?
Section 5 — Dental Anxiety
It's completely okay to feel nervous. Letting us know helps us look after you better. How would you describe your anxiety level around dental visits?
Please upload a photo of your insurance card:
Thank you for completing your registration. We look forward to welcoming you and making sure you're comfortable throughout your visit.