New Patient Form

Please take your time to complete this form in as much detail as possible. All information is kept STRICTLY confidential. We do not share any of your records with anyone unless you authorise us to do so.

I have completed this form to the best of my knowledge, and understand that failure to make a full disclosure may place me at undue medical risk. I understand that the payment is due in full the same day as treatment is provided unless agreed in writing prior to starting treatment e.g. approved payment plan. I also give my permission for the practice to use the above contact details to send me an appointment and check-up reminders.