COVID-19 Screening: Have you travelled overseas/interstate, felt unwell (fever, cough), or had contact with a suspected case in the past 14 days?
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By signing this form you agree to our terms and conditions:
1. Information is collected per state and Federal Privacy Legislation.
2. To the best of my knowledge, I have accurately completed this medical history form.
3. I authorize treatment to be carried out by the dentists and their staff.
4. I agree to be responsible for payment at the time of service.
5. I authorize clinical images (identity remains anonymous).
6. Treatment plans and prices are subject to change without notice.