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New Patient Medical History Form

Helping Us Provide the Safest, Most Personalised Care
Welcome to Hunters Hill Orthodontics. To ensure we can provide you with the safest, most effective, and most personalised care possible, we require all new patients to complete a comprehensive medical and dental history form before their first appointment.

Please fill in all fields marked with *

Patient Information

Title
Gender *

Dental History

Have you previously worn orthodontic appliances or had orthodontic treatment? *
Have you ever had an accident involving teeth or jaw? *
Have you ever had clicking noises or pain in your jaw? *

Medical History

Have you ever had any of the following conditions? *
Is there a possibility that you could be pregnant? *
I certify that the above medical history is accurate at this time. If there are future changes, I will inform the practice. *

Practice Related

How did you hear about us? *
Have any of your family members and/or friends had treatment with us? *
Do you have Private Health Insurance? *

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For any photos, x-rays or additional information you wish to submit alongside this form, please upload here.

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Visit Us

Our team in Hunters Hill is here to help you book an appointment or answer any questions you may have.

Location58 - 60 Gladesville Rd
Hunters Hill NSW 2110

Phone(02) 8054 2722

Emailinfo@huntershillorthodontics.com.au

Opening timesOpening Times
Monday - Thursday
8:30am - 5:30pm

If visiting the practice without an appointment, please call ahead.

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