Medical History UpdateDental Implants From As Little As $1,500* (Includes The Implant - Additional Fees Apply For Prosthetic Component & Bone Grafting)Medical History Medical History Name: * Date of Birth: * Contact Number: * Address Email * Please check the appropriate boxes Heart Conditions Yes No Details/Medications 500 characters left Rheumatic Fever Yes No Details/Medications 500 characters left Blood Pressure Problems Yes No Details/Medications 500 characters left Asthma Yes No Details/Medications 500 characters left Blood Disorders Yes No Details/Medications 500 characters left Bleeding Problems Yes No Details/Medications 500 characters left Kidney Problems Yes No Details/Medications 500 characters left Hepatitis / Liver Disease / HIV Yes No Details/Medications 500 characters left Diabetes Yes No Details/Medications 500 characters left Radiotherapy / Chemotherapy Yes No Details/Medications 500 characters left Local Anaesthetic Problems Yes No Details/Medications 500 characters left Other Illness / Disability / Epilepsy Yes No Details/Medications 500 characters left Are You Taking Any Medication? Yes No If the answer is yes, please list: 500 characters left reCAPTCHA If you are human, leave this field blank.Submitgeneral dentistrycrowns & veneersimplant surgeryRoot canal treatmentCHILDREN’S dentistryteeth whiteningmicroscope dentistrypain managementEMERGENCY DENTISTRYReady to get started?BOOK AN APPOINTMENT TODAYAccreditation &MembershipsWe accept all major Health Funds