Medical
history.

your medical history.

The following information is requested to enable us to give you our best attention. Each question is relevant to modern dental practice and is confidential.

    Type of private health insurance for dental treatment:

    SmilenibHCFmedibank privateTUHMBF, HBA, Bupaveterans affairdefence healthothernone

    Is there any reason for you to suspect that you may have AIDS, Hepatitis or are HIV positive?

    yesno

    Have you taken Aspirin, Warfarin, Pradaxa, Xarelto, Equilis or any other blood-thinning medications?

    yesno

    Have you ever taken any Bisphosonate medication – usually prescribed for osteoporosis (poor bone density), Paget’s disease and in some cancer treatments?

    yesno

    Have you ever been advised by a doctor or dentist (because of prior surgery, heart disease etc) that you require an antibiotic cover as a precautionary measure whenever you have routine dental treatment?

    yesno

    Please tick if you have any of the following:

    rheumatic feverheart murmurepilepsydiabetesasthmacontact with HIV/AIDSprosthetic joints/vascular surgeryhaemophilia/prolonged bleedingheart condition/pacemaker/cardiac surgeryhigh blood pressure/any blood disorderkidney diseasehepatitis Ahepatitis Bhepatitis Ccancerallergy to aspirinallergy to penicillinallergy to latexany other allergies to drugs/food/medicine(ladies only) are you pregnant?

    any other illness/disability

    I have confidential information that I do not wish to write down. I would prefer to speak to the Dentist about this.

    your medical history.

    The following information is requested to enable us to give you our best attention. Each question is relevant to modern dental practice and is confidential.

      Type of private health insurance for dental treatment:

      SmilenibHCFmedibank privateTUHMBF, HBA, Bupaveterans affairdefence healthothernone

      Is there any reason for you to suspect that you may have AIDS, Hepatitis or are HIV positive?

      yesno

      Have you taken Aspirin, Warfarin, Pradaxa, Xarelto, Equilis or any other blood-thinning medications?

      yesno

      Have you ever taken any Bisphosonate medication – usually prescribed for osteoporosis (poor bone density), Paget’s disease and in some cancer treatments?

      yesno

      Have you ever been advised by a doctor or dentist (because of prior surgery, heart disease etc) that you require an antibiotic cover as a precautionary measure whenever you have routine dental treatment?

      yesno

      Please tick if you have any of the following:

      rheumatic feverheart murmurepilepsydiabetesasthmacontact with HIV/AIDSprosthetic joints/vascular surgeryhaemophilia/prolonged bleedingheart condition/pacemaker/cardiac surgeryhigh blood pressure/any blood disorderkidney diseasehepatitis Ahepatitis Bhepatitis Ccancerallergy to aspirinallergy to penicillinallergy to latexany other allergies to drugs/food/medicine(ladies only) are you pregnant?

      any other illness/disability

      I have confidential information that I do not wish to write down. I would prefer to speak to the Dentist about this.

      your medical history.

      The following information is requested to enable us to give you our best attention. Each question is relevant to modern dental practice and is confidential.

        Type of private health insurance for dental treatment:

        nibHCFmedibank privateTUHMBF, HBA, Bupaveterans affairdefence healthothernone

        Is there any reason for you to suspect that you may have AIDS, Hepatitis or are HIV positive?

        yesno

        Have you taken Aspirin, Warfarin, Pradaxa, Xarelto, Equilis or any other blood-thinning medications?

        yesno

        Have you ever taken any Bisphosonate medication – usually prescribed for osteoporosis (poor bone density), Paget’s disease and in some cancer treatments?

        yesno

        Have you ever been advised by a doctor or dentist (because of prior surgery, heart disease etc) that you require an antibiotic cover as a precautionary measure whenever you have routine dental treatment?

        yesno

        Please tick if you have any of the following:

        rheumatic feverheart murmurepilepsydiabetesasthmacontact with HIV/AIDSprosthetic joints/vascular surgeryhaemophilia/prolonged bleedingheart condition/pacemaker/cardiac surgeryhigh blood pressure/any blood disorderkidney diseasehepatitis Ahepatitis Bhepatitis Ccancerallergy to aspirinallergy to penicillinallergy to latexany other allergies to drugs/food/medicine(ladies only) are you pregnant?

        any other illness/disability

        I have confidential information that I do not wish to write down. I would prefer to speak to the Dentist about this.

        book your appointment today.