Confidential Medical and Dental History Form

It is important to know details about your child’s dental / medical history, as it forms part of vital records for your child’s treatment with Paediatric Dental Group. Please note we require every field to be completed to ensure a complete record.

The information you provide is confidential and will be handled in accordance with our Privacy Policy.

Online Referral

We have developed an online facility for you to refer your patient and attach x-rays.
If you would prefer to email or fax you are more than welcome to.

Fax: 07 3009 0094