New Patient Medical History Form
Please complete New Patient Medical History Form
before attending your appointment at Sarina Dental Care

Sarina Dental New Patient Form

It is important to know details about your medical history as this could affect the success & safety of your Dental Treatment. All information provided is totally confidential & will be handled in accordance with our Privacy Policy

Name
Title
MM slash DD slash YYYY
Are you Covered For Dental Treatment (Extras) With Your Private Health Fund:
Can We Contact This Person If Your Unavailable

A MINIMUM OF 24 HOURS NOTICE IS REQUIRED IF YOU WISH TO CANCEL YOUR APPOINTMENT: PHONE 4943 0083. ALL IMAGES / PHOTOGRAPHS REMAIN THE PROPERTY OF SARINA DENTALAND MAY BE USED FOR ONGOING RESEARCH AND PROFESSIONAL DEVELOPMENT PURPOSES.

ATTENTION: FAILURE TO ATTEND AN APPOINTMENT OR LESS THAN 2 HOURS NOTICE TO CANCEL AN APPOINTMENT WILL INCUR A FEE

PLEASE COMPLETE ALL THE FOLLOWING INFORMATION TO THE BEST OF YOUR KNOWELEDGE THIS WILL HELP US TO UNDERSTAND YOU:

MM slash DD slash YYYY
MM slash DD slash YYYY
Have you had any of the following treatments?

Opening Hours

Monday: 8am - 6pm

Tuesday, Thursday & Friday: 8am - 5pm

Wednesday: 9am - 6pm

Saturday: As required

Emergency Appointments

If you require urgent dental care, please call us.
We’ll do our best to fit you in for a same-day appointment.
Emergency Dental

Payment Methods

We accept a wide range of payment options for your convenience:
• Eftpos
• Cash
• Cheque
• Visa / Mastercard / American Express
• Afterpay & ZipPay now available
• HICAPS (for on-the-spot health fund rebates)

What Our Patients are Saying

“It’s a pleasure to walk into Sarina Dental Care, where you are welcomed with warm greetings and smiles at the front desk.”

Julie Dalglish
9 Months Ago

“I was very nervous about the appointment and the dentist was amazing! Very kind, caring and steady with her work! I was made comfortable in no time. And to finish it all off it was a great price!”

Nick Parsgaard
3 Months Ago

“Great customer service, explained what I needed to do to keep my teeth healthy in an easy to understand way.
Constant reassurance throughout my appointment. Very thorough, thank you.”

Kirsten Jensen
3 Months Ago
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07 4943 0083
  • sarinadental@gmail.com
  • Shop 4, Central St Plaza,
    22 Central St, Sarina QLD

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Our Services

  • Service Offerings
  • General Dentistry
  • Advanced Treatments
  • Children's Dentistry
  • Emergency Dental
  • Aftercare

Opening Hours

Mon: 8am -6pm
Tues, Thurs & Fri: 8am -5pm
Wed: 9am -6pm
Sat: As required
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