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222 Lutwyche Road | Windsor | North Brisbane
Windsor Dentists Logo

Open 6 Days, Evening & Weekend Appointments Available
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07 3357 4177
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Opening Hours

  • Easter Holiday Closure
  • HOME
  • ABOUT US
    • Get to Know Us
    • Why Choose Us?
    • Why Are We Different?
    • Your Dental Team
  • OUR PROCEDURES
    • General
      • Regular Dental Checkups
      • Dental Emergencies
      • Scale and Clean
      • Root Canal Therapy
      • Tooth Extraction
      • Wisdom Teeth Removal
      • Gum Disease Treatments
      • Fissure Sealants
      • Porcelain Crowns
      • Dentures
      • Grinding or Clenching | Protective Guards
      • Zirconia Crowns
      • Dietary Advice
      • Personalised Oral Hygiene Advice
      • View Before & Afters

        before and after
    • Cosmetic
      • Tooth Whitening | Boost & Zoom Whitening
      • Dental Bonding
      • Amalgam Removal & Replacement
      • Invisalign
      • Veneers
      • White Porcelain Fillings
      • Bioclear – Black Triangle and Gappy Smile Closure
      • Enamel Microabrasion | Remove Tooth Discolouration
      • Dental Implants
        • Single Teeth Replaced with Implants
        • Multiple Teeth Replaced with Implants
      • Implant Bone Grafting
      • Mini Dental Implants
    • Advance Services
      • Tooth Wear Treatment & Reconstruction
      • Sedation and Penthrox Gas for Anxious Patients
      • Oral Cancer Screening
      • Saliva & Oral pH Testing
      • TMD and Bruxism Relief | NTI Splints
      • Bioclear
      • SomnoDent Sleep Apnea Appliance
      • Anti Snore and Sleep Apnoea Devices
      • Digital Xrays and Imaging
  • DENTAL CONCERN
    • Need a checkup or after some dental advice?
    • Unhappy about your dentures?
    • Anxious or worried seeing the dentist?
    • Failing dentistry or constantly breaking teeth?
    • Have sore or sensitive teeth?
    • Concerned about bleeding or sore gums?
    • Looking for the best type of crown
  • BLACK TRIANGLES CLINIC | BIOCLEAR
  • FORMS & PATIENT INFO SHEETS
    • Online Medical History
    • Patient Forms
    • Dental Information Sheets
      • Dental Information Sheets
      • Common Dental Conditions
      • Information Regarding Your Procedure
      • Post Operative Care Instructions
  • FEES & PAYMENT OPTIONS
    • Payment Options
    • Payment Plans
    • New Patient Fees
    • Health Funds
    • Child Dental Benefits Schedule
    • Department of Veterans’ Affairs
  • BOOK ONLINE
  • CONTACT US
    • Enquiries & Contact Details
    • Getting to Us
  • Easter Holiday Closure
  • HOME
  • ABOUT US
    • Get to Know Us
    • Why Choose Us?
    • Why Are We Different?
    • Your Dental Team
  • OUR PROCEDURES
    • General
      • Regular Dental Checkups
      • Dental Emergencies
      • Scale and Clean
      • Root Canal Therapy
      • Tooth Extraction
      • Wisdom Teeth Removal
      • Gum Disease Treatments
      • Fissure Sealants
      • Porcelain Crowns
      • Dentures
      • Grinding or Clenching | Protective Guards
      • Zirconia Crowns
      • Dietary Advice
      • Personalised Oral Hygiene Advice
      • View Before & Afters

        before and after
    • Cosmetic
      • Tooth Whitening | Boost & Zoom Whitening
      • Dental Bonding
      • Amalgam Removal & Replacement
      • Invisalign
      • Veneers
      • White Porcelain Fillings
      • Bioclear – Black Triangle and Gappy Smile Closure
      • Enamel Microabrasion | Remove Tooth Discolouration
      • Dental Implants
        • Single Teeth Replaced with Implants
        • Multiple Teeth Replaced with Implants
      • Implant Bone Grafting
      • Mini Dental Implants
    • Advance Services
      • Tooth Wear Treatment & Reconstruction
      • Sedation and Penthrox Gas for Anxious Patients
      • Oral Cancer Screening
      • Saliva & Oral pH Testing
      • TMD and Bruxism Relief | NTI Splints
      • Bioclear
      • SomnoDent Sleep Apnea Appliance
      • Anti Snore and Sleep Apnoea Devices
      • Digital Xrays and Imaging
  • DENTAL CONCERN
    • Need a checkup or after some dental advice?
    • Unhappy about your dentures?
    • Anxious or worried seeing the dentist?
    • Failing dentistry or constantly breaking teeth?
    • Have sore or sensitive teeth?
    • Concerned about bleeding or sore gums?
    • Looking for the best type of crown
  • BLACK TRIANGLES CLINIC | BIOCLEAR
  • FORMS & PATIENT INFO SHEETS
    • Online Medical History
    • Patient Forms
    • Dental Information Sheets
      • Dental Information Sheets
      • Common Dental Conditions
      • Information Regarding Your Procedure
      • Post Operative Care Instructions
  • FEES & PAYMENT OPTIONS
    • Payment Options
    • Payment Plans
    • New Patient Fees
    • Health Funds
    • Child Dental Benefits Schedule
    • Department of Veterans’ Affairs
  • BOOK ONLINE
  • CONTACT US
    • Enquiries & Contact Details
    • Getting to Us

Online Medical History

Home/Online Medical History
Online Medical HistoryWindsor Dentists2022-02-08T20:57:56+10:00

Online Medical History Form

  • Welcome! It is important to know details about your medical history as these could affect the success of your dental treatment and how we can provide this treatment safely for you. To provide you with the best possible care, please complete ALL SECTIONS of this form. The information you provide is confidential and will be handled in accordance with our privacy policy.

    If you would like to fill a printable copy of this form to bring in, please click here.
  • General Patient Information

  • DD slash MM slash YYYY
  • If you don't have a home phone, please enter your main contact phone number.
  • Contact Email
  • ⚠️ Please remember to bring your health fund card to your appointment. We are unable to process claims without the physical card being present at the time of your appointment. ⚠️
  • Dental Information

    To ensure we have an accurate background to your existing and previous dental health, please indicate if you have or have not had any of the following diseases or problems.
  • Medical Information

    To ensure your dental treatment remains safe, please indicate if you have or have not had any of the following diseases or problems.
  • Please type "None" it you don't have a current medical practitioner
    Women only
    Women Only
  • Medications & Other Products/Substances

    If yes, click "Yes" and please list all or upload list of medications
  • Drop files here or
    Accepted file types: jpg, bmp, png, pdf, doc, docx, Max. file size: 128 MB.
      If you have a scanned medication list, you can upload it here.
    • Medical Conditions and Allergies

    • Please list if any
    • - That my personal and medical information will be treated in the strictest confidence in accordance with the QLD Information Privacy Act 2009

      - That all treatment is to be paid for on the day of treatment and that no accounts are issued

      - That to keep things fair for all our patients and our staff, we ask you to provide 24 hours notice if you are unable to attend your appointment or require a cancellation
    Save and Continue Later

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    • Payment Plans

    How can we help you?

    • Need a checkup or after some dental advice?
    • Want to improve your smile?
    • Unhappy about your dentures?
    • Anxious or worried seeing the dentist?
    • Failing dentistry or constantly breaking teeth?
    • Have sore or sensitive teeth?
    • Concerned about bleeding or sore gums?
    • Do you have jaw, headaches or neck pain?
    • Want more info on replacing missing teeth with dental implants?
    • Want more info on straightening your teeth
    • Want to know more about Invisalign (braces without wires)?
    • Looking for a practice that is great with kids?