I would like to welcome you to my practice. This questionnaire is confidential and filling out this form helps us provide the best possible care and treatment for you. To optimise your treatment time, please complete and submit this form at least one week prior to your appointment.

Please arrive 15 minutes earlier than the scheduled appointment time to allow for pre-treatment administration.

Antibiotics: If your medical practitioner or medical specialist advised you that your medical condition or joint replacement requires antibiotic coverage prior to dental appointments, then they must be taken prior to a periodontal consultation and or treatment. If the antibiotics were not taken as advised then the examination cannot occur.