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(03) 8199 9949

bookings@wintersmiles.au

Patient Contact Details & Medical History Form

YOUR MEDICAL AND DENTAL HISTORY

NEW PATIENTS

As a new patient to our Practice, to help facilitate in providing you with quality personal and dental care, we need to gain a thorough understanding of your medical and dental history. For this reason, we will request that you complete our “Patient Contact Details & Medical History Form”. For your convenience, we have made this Form available as a PDF download. If you are unable to complete the Form prior to your initial appointment, please arrive 10 minutes early so that you will have time to fill out a hard copy on the day.

Click the button below to view and download the PDF form:

NB: This Form can be filled out electronically on your phone and then emailed to us. Alternatively, it can be completed on a computer but you may need to download it first to be able to fill it out electronically. You can then attach the completed Form to an email and send it to us.

EXISTING PATIENTS

As an existing patient, it is important that your contact details and medical history remain up-to-date so that we can continue taking care of you in the best possible way. For this reason, we will request that you complete our “Existing Patient Contact Details & Medical History Update Form” every 12 months. For your convenience, we have made this Form available as a PDF download.

Click the button below to view and download the PDF form:

NB: This Form can be filled out electronically on your phone and then emailed to us. Alternatively, it can be completed on a computer but you may need to download it first to be able to fill it out electronically. You can then attach the completed Form to an email and send it to us.

WHY THESE FORMS ARE IMPORTANT

Patients often ask us why they need to fill out this Form (especially if they have seen Eden before at another dental practice). As a response, we have put together some questions and answers below to help you understand why. The Form may seem annoying, but it is our best source of information to help keep you safe and healthy. 

 

QUESTIONS AND ANSWERS

Why do I need to complete a Patient Medical History Form?

As a dentist in Australia, Eden is required by law to have his patients complete and update a medical history form every 12 months.

However, it is not just as a legal requirement. Eden treats his patients holistically, rather than just assessing their teeth. This means that Eden needs to know about your general health so that he is able to plan your care properly. At Winter Smiles, our focus is on helping you with preventative dental care to ensure that your teeth and gums remain healthy, rather than just repairing the problem.

Why do I need to complete a Patient Medical History Form if I have seen Eden before?

While you may have seen Eden before at another dental practice, we do not automatically have access to that dental practice’s records. Even if we do, it is important to ensure that your medical history is up-to-date so that Eden can take care of you in the best way possible.

Why does Eden need to know the answers to some of the questions on the Form?

The Form is a comprehensive medical history form. Although some of the questions may seem strange for your dentist to ask, all of the questions on the Form are relevant. The answers let Eden know if you may be at increased risk of certain oral health diseases or if some health conditions and medications may affect treatment options.

For example:

  • Information about certain medical conditions such as diabetes, epilepsy, allergies or heart disease could be vital if a medical emergency occurs at the Practice.
  • Patients with heart conditions and/or stents, joint replacements or other conditions that require careful monitoring may require a prophylactic course of antibiotics prior to dental treatment to be safe.
  • Even a thyroid condition may hinder the body’s ability to heal wounds and this is then related to extractions (i.e. removal of teeth) a patient may need now or in the future.
  • Allergies to medications and/or uncontrolled high or low blood pressure may cause consequences if Eden is not informed about these conditions.
If you have any questions about these Forms or have trouble filling them out, please do not hesitate to contact us.