New Patient Form

If you have not visited our practice before, please fill out the required fields (marked *) and any other helpful information in new patient form below. This information, which will remain strictly private and confidential, will provide us with a better understanding of your dental and oral health needs as well as your medical history so that we can better serve you at our Sydney dentist office.

If you have any questions regarding this form or to make an appointment by phone, please call 02 9241 2038.

Contact Us
First
Last
Address
Address
City
State
Post Code


Please mark every box (YES or NO) and specify for each condition
Heart Condition
Blood Pressure
Diabetes
Rheumatic Fever
Artificial Valves/prostheses
Heart Murmur
Prolonged Bleeding
Gastric Problems
Arthritis
Osteoporosis
Eating Disorder
Sleep Apnoea
Asthma
Hepatitis
HIV/AIDS positive
Are you a smoker?
Are you Pregnant?

Do you have any allergies?
Type/s of Allergies
Do you take any medications?
Reason for presenting to the practice?
Your smile
Are you happy with the look/shape/colour and alignment /spacing of your teeth?
Would you like to know more about Botox offered at Quay Dental for clenching or cosmetic reasons?
Would you like to know more about veneers/ whitening or have our gap free Invisalign consultation?

Cancellation Policy

It is our practice policy that you provide at least 24 hours notice if you are unable to keep an appointment. If due notice is not given a fee of $50 will apply for all appointments not attended.