Gordon (02) 9122 1900 Hurstville (02) 9570 8804
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Medical history form for new patients

To ensure we have all the information we need for your first visit, please fill out the appropriate medical history form below.

Patient information

Dental History

Have you previously worn orthodontic appliances or had orthodontic treatment?*

Have you ever had an accident involving teeth or jaw?*

Have you ever had clicking noises or pain in your jaw?*

Medical History

Have you ever had any of the following conditions?*

Practice related

Do you have Private Health Insurance?*

For further information about how we use your data, please see our privacy policy.