New Patient Information & Medical History

Title

Preferred Method of Reminders *

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Do you smoke? *

Are you pregnant? *

Anaemia/Blood Disorder *

Epilepsy or Seizures *

Asthma *

Heart Attack/Murmur *

Artificial Joints *

Hepatitis A/B/C *

Arthritis *

HIV *

Blood Pressure (High/Low) *

Mental Health Condition *

Blood Thinners *

Osteoporosis *

Cancer (Past/Present) *

Pacemaker/Cardiac Surgery *

Cholesterol (High/Low) *

Reflux *

Diabetes (Type 1/Type 2) *

Rheumatic Fever *

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Dentists in Torrensville | Thebarton | Mile End | Hilton | Cowandilla | Brooklyn Park | Underdale | Hindmarsh | Welland | Allenby Gardens | Flinders Park | Western Adelaide SA

AFFORDABLE DENTISTS IN TORRENSVILLE | THEBARTON | MILE END | HILTON | COWANDILLA | BROOKLYN PARK | UNDERDALE | HINDMARSH | WEST HINDMARSH | WELLAND | ALLENBY GARDENS | FLINDERS PARK | WEST ADELAIDE | SOUTH AUSTRALIA | (08) 7120 2719