Smilecare Family Dentists. Affordable high quality dental care.

Welcome to Smile Care Family Dentists. Making high quality dental more affordable for everyone.

Please fill in this questionnaire with accuracy as we would like to get to know you.

Download our New Patient Form PDF from here, or fill in the form below.

Email us

Surgery Opening Hours

Mon - Sat: 8am - 5pm
We also offer extended opening
hours for emergencies.

Our Location

Level 2, Suite 9, 6 McIntosh St
Chatswood, NSW 2067 Australia

Find us on google maps now

Parking

Click here for parking information

Corporate Dental Program

SmileCare Dental & DENTAL CARE NETWORK™ are offering a dental program which provides an exclusive voucher of $100 to be redeemed for dental treatment if you are an employee of one of our partnered corporate programs.

Patient Referral Program

It gives us great pleasure knowing so many of our patients have recommended our high quality service to family, friends and colleagues. We appreciate this compliment and have sent out many rewards to our patients to say thank you for the referrals.

New Patient Offer $195

Full Dental Assessment (Save $105)

Full Comprehensive Examination
Professional Clean and Polish
Diagnostic X-Rays (if required)
Fluoride Treatment
Digital guided tour of your mouth

Online Patient Form

To complete or download our medical and dental history form before your first appointment.

Any surgical or invasive procedure carries risks. Before proceeding with a surgical or invasive procedure, you should seek a second opinion from an
appropriately qualified health practitioner.

Title:
Surname:*		Given Name:*
Preferred Name:		Date of Birth:*
Address:*		Suburb:*
Postcode:*
Ph (home):*		Mobile number:
Ph (work):
E-mail:*
Yes No Would you like to be kept informed with updates on what is new in the practice, service and new dental techniques that may be of benefit to you?
Yes No Would you allow us to use your x-rays/images for ongoing patient education? Please note your name and/or any other personal details will remain disclosed.
Name of Private Health Fund (if any)		Position No on card:
Occupation:		Employer Name:

Name:	Relationship:	Phone:
In case of an emergency whom should we contact? Please indicate if different to next of kin.
Name:	Relationship:	Phone:

We remind our patients of their appointments. If you would like us to do this please indicate the preferred means of contact.
SMS	Mobile	Hm phone	Work phone	E-mail


Referral Source:
Referred by another patient who?
Referred by staff who?
Other
Company Referred By who?

Have you had or are you suffering from any of these? (please tick)
Heart Trouble / Surgery Cardiac Pacemaker High blood pressure Low blood pressure Diabetes Hepatitis Rheumatic Fever Arthritis Thyroid trouble Epilepsy Sleep Apnoea Stroke Stomach or digestive condition/reflux Osteoporosis	Nervous Disorders Asthma HIV/AIDS Liver or kidney disease Excessive or prolonged bleeding Radiation or chemotherapy Eating disorder Prosthetic implant/joint replacement Organ or bone marrow transplant Steroid therapy Other (specify) Are you or could you be pregnant? Do you smoke?
Are you allergic to anything eg local anaesthetic, latex, penicillin, peanut, etc (please specify)
What medications including natural remedies are you taking?

How do you rate your general health? Excellent Good Poor Fair
Who is your general practitioner?
Telephone: