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  • At Dental Care Professionals, we strive to provide you with the highest possible care.

    To do this we need to collect personal information from you that includes contact details and matters pertaining to your general health, both past and present.

    Without this information it is difficult for your dentist or hygienist to plan your care properly.

  • Personal Details

  • Phone

  • Next of Kin/Emergency Contact

  • Private Healthcare

    Please provide Private Healthcare Fund as applicable. If you're not a member of a Private Health Fund, just type in "N/A".
  • Medicare

    Please provide Medicare details as applicable. If you don't have these details available, please enter "TBA" or "N/A".
  • Enter the expiration date on your car as MM/YYYY (e.g. 05/2013)
  • Appointments

  • Medical History

  • Have you had or are you suffering from any of the following?
  • General Practitioner Details

  • Cardiac Conditions

  • Medications

  • Dental History

  • How Did You Hear About Us?

  • I accept the ultimate responsibility for payment of all dental treatment carried out on myself, including any fees from missed appointments or appointments cancelled with less than 24 hours notice, and agree to pay all fees at the time of the appointment unless prior arrangements have been made. In default, I agree to pay all account handling fees and collection charges for overdue accounts.
  • Payment Options

    Comprehensive range of payment options & plans available

  • HICAPS

    Health fund rebates directly through your private health insurance.

  • Appointments

    Fast and easy way to schedule your next dental appointment

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