Skip to content

Medical History Form

In order to provide you with the highest standard of dental care, this practice is required to collect personal information from you. This information covers basic details such as your name, address and phone numbers, but it is also necessary for the dentist to obtain from you details regarding your general health and past medical or surgical events.

Please print out and fill in the Patient Registration and Health History form and scan and email it back to reception@mundaringdentalcentre.com.au. Alternatively, print it out, fill it in and bring it with you to your appointment. If you are not able to do so prior to your appointment, please arrive 10 minutes earlier than your appointed time so that filling in the form doesn’t cut into your time with our clinicians.