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Dental Implants

Can improve your smile and dental function.

 
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Fissure Sealant

Protect your children's teeth from decay.

 
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Orthodontics

Correcting irregularly placed or crooked teeth.

 

Comprehensive Consultation

Includes Oral Cancer Check, Soft and Hard Tissue exam, Jaw Joint Analysis, and laser Caries Diagnosis - The most advanced European method for early detection of decay especially in children. It can reduce the need for x-rays, but does not replace them.

Fees: $57 Standard, $98 Extended

Your Medical history should be updated regularly

Title
First Name *
 Last Name *
Address
City
 State
PostCode
 Country
Email Address *
Phone (H)
 Phone (W)
 Phone (M)
Date Of Birth
23-02-2012
Occupation & Employer

Medical History Questionnaire

Please read this document carefully, and answer all questions accurately. The information is in confidence, and enables me to provide treatment appropriate to your medical condition. Many drugs taken, and disease states, will of necessity change the possible choices for your optimal dental treatment.

Why do we ask these questions? Diabetics have a delayed healing time, and endodontics may not be suitable. Anti-hypertensive drugs (high BP) may cause adverse reactions if certain local anaesthetics drugs are being used. Many people take anti-coagulants, and this prolongs bleeding times if surgery is required. Angina patients need to bring their tablets to all appointments. The contraceptive pill (and HRT) interacts with antibiotics to such an extent that alternate methods of contraception need to be used. Some local anaesthetics are contraindicated due to severe side affects if Viagra has been recently used. Liver disease prolongs bleeding times. Rheumatic Fever patients require antibiotics coverage for certain dental procedures to prevent the possibility of further heart valve damage.

Shortness of breath may be a symptom of an underlying cardiac or respiratory problem.

Who is your Private Health Insurance Company? *
Do you have Dental Cover? *
Yes    No
Private Health Fund Member Number:
 Series:
Have you ever had an Allergic or Adverse reaction to any drugs? *
Yes    No
Do you take Drugs/Medications Regularly? *
Yes    No
Have you had any Health Problems this year? *
Yes    No
Who is your usual Medical Doctor? *
Have you ever had a general anaesthetic? *
Yes    No
Who referred you to us? *
Are you happy with your Dental Appearance / Function? *
Yes    No

Do you suffer from, or have you ever had any of the following?
Please click the YES box under the (Yes), if that is the case, and give details in the space provided below. (Other Details Box)

Problems: Yes Problems: Yes
Heart Disease Vascular Disorder
Shortness of Breath Asthma
Blood Pressure Irregularities Rheumatic Fever
Diabetes Liver Disease or Hepatitis
Kidney or Bladder Disease Epilepsy or Psychiatric Disorder
Allergy or Hypersensitivity Blood Transfusion
Prolonged Bleeding following Surgery Anticoagulant Therapy or recently taken Aspirin
Females, are you possibly Pregnant * Females, are you on Hormone Replacement Therapy *
Females, Do you take the Contraceptive Pill * Males, Have you used Viagra in the last 24 Hours *
Have you ever taken Growth Hormone Products *, OR Females, have you ever taken Hormones to promote fertility * AIDS / HIV (You may inform the surgeon rather than write)
Do you take any NON Prescription Drugs * Yes Answers greatly influence drugs we may safely use

* = Required fields
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