Thank you for selecting your appointment time.

One last step – please complete the New Patient medical form below which will be submitted to our team.
Complete Form

New Patient Medical Form

Please complete and click submit when done.

New Patient Form
Please provide a different contact number and name than above.
Please list any known allergies.
If none, please write No Healthfund.
Example: 1234 56789 01 05/2023
Example: Dr Tooth at ABC Dental.
How did you hear about us?
Please select as many as apply.
Preferred Practice Location
If orthodontic treatment is deemed necessary, how soon would you like to get started?