Update on Coronavirus (COVID-19)   Read More

Medical History Form

  1. Home
  2. Medical History Form

Medical History Form

  1. Home
  2. Medical History Form

Step 1 of 5

WE RESPECT YOUR PRIVACY

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 telephone number but it is also necessary for us to obtain from you details regarding your general health and past medical or surgical events. Without this general health picture, the treating Dentist or Hygienist is unable to plan your care properly.

Naturally, some of this information is of a personal nature and some of it might be regarded as "sensitive" and not the sort of information that you would wish to be unnecessarily disclosed to others.

We value the need to safeguard this information and, in accordance with the principles laid down in privacy legislation and the guidelines issued by the Australian Dental Association, we would like to assure you that:

  • This information will only be used by the treating Dentist or Hygienist in order to deliver your care to the highest standards.
  • It will not be disclosed to those not associated with your treatment, without your express consent as provided under the legislation and where we consider you would have a reasonable expectation of us to provide such information.
  • You may seek access to the information held about you and we will provide this access without undue delay. This access might be by inspection of your dental records at the time of appointment or by special access or copying of information at other times.
  • There will be no charge made for requesting this information but there may be fees levied just to cover the costs associated with the processing of this request or the copying of information.
  • We will take reasonable steps to ensure at all times that the details we keep about you are accurate, complete and up-to-date.
  • We will take reasonable steps to protect this information from misuse or loss and from unauthorised access, modification or disclosure.
  • Our staff is trained to respect these principles at all times.
If you have any questions regarding the information we collect from you and hold in your dental records, please do not hesitate to ask us. We are acting in your interests at all times.

Download Free Price List

Please enter your email so we can send you the price list in the next few minutes.

You have Successfully Subscribed!

Creating The Smile You Love Webinar

Thinking of upgrading your smile but not sure what to expect? Watch this webinar as Dr Ghobrial takes you through 3 patients’ smiles he transformed right here in Brisbane

You have Successfully Subscribed!