Medical
history.

Medical
history.

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: 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.

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.

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.

book your
appointment
.

proud recognised provider.

accredited dental practiceaustralian dental association memberahpraaustralian government department of veterans affairsmetro south health oral health services

nib first choicemedicare child dental benefits schemeziphcf logo

proud recognised provider.

accredited dental practiceaustralian dental association memberahpra

australian government department of veterans affairsmetro south health oral health servicesnib first choice

medicare child dental benefits schemeziphcf logo

proud recognised provider.

accredited dental practiceaustralian dental association member

ahpraaustralian government department of veterans affairs

metro south health oral health servicesnib first choice

medicare child dental benefits schemezip

hcf logo