Email Us07 839 4041

We Welcome New Patients

If you would like to join our patient register please call our office on 07 839 4041 We will ask you to provide some details with regards to your dental history and future needs.

We offer a very personal and skilled level of service to all clients and treat them almost as members of our extended family. If you would like to know more please call us. Let us show you we care about your smile!

We have free parking that is available right outside our door. Our building is a single story complex with easy ramp access and a convenient pharmacy and medical centre all located in the same complex.

 


New Patient Questionnaire

 

Personal Details

Title *
 
Full Name *
 
Preferred Name
 
Date of Birth *
 
Full Postal Address & Post Code *
Home No
 
Work No
 
Mobile No *
 
Email Address *
 
Occupation
 
An emergency contact person's full name and number *
Who was your last Dentist and how long ago since your last visit *
Your Doctors name and contact details if known *
Do you have Dental Insurance cover?
 
How Did You Hear About Us?
 
 

Medical Information

Do you normally require antibiotic cover before dental treatment? *
 
Have you had any abnormal reactions to local or general anaesthetic? *
 
Do you smoke? *
 
Females - Are you pregnant or possibly pregnant? *
 
Are you being treated by a doctor at present? *
 
Have you or Your Household Returned from Overseas in the Last 10 days? *
 
Have you been hospitalised in the last 12 months? *
 
Are you taking any medication? Please list below
Do you have any allergies?
Latex, Penicillin etc
Tick if you have had any of the following
 
Anything else we should know?
 
 
 
 

Contact Details

91 Kahikatea Drive
Melville
Hamilton 3206

Phone 07 839 4041

Open Hours

Monday: 8am to 6pm
Tuesday: 8am to 5pm
Wednesday: 8am to 5pm
Thursday: 8am to 5pm
Friday: 8am to 4pm
Saturday: By appointment only
Sunday: Closed