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 &Memberships(opens in new tab)(opens in new tab)We accept all major Health Funds(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)(opens in new tab)
