Blue Tooth Dental
(02) 9519 2691

Book Now

(02) 9519 2691

Book Now

  • About Us
  • Patient Experience
    • FREE Offers
      • Free Take Home Kit
      • Free Wisdom Teeth Consultation
      • Free Dental Implant Consultation
    • Payment Plan
      • Payment Plan
      • AfterPay
    • Kids Dental Offers
      • Kid’s No Gap Check up and Clean
      • Child Dental Benefits Schedule
    • HICAPS Easyclaim
    • Sedation
      • Happy Gas
      • IV/Twilight Sedation
  • General Dentistry
    • Check-Up And Teeth Clean
    • Restoratives
    • Wisdom Teeth Surgery
    • Children’s Dentistry
    • Dental Implants
    • Root Canal Treatment
    • Dentures
  • Cosmetic Dentistry
    • Veneers
    • Teeth Whitening
    • Dental Jewellery
  • Orthodontic Treatment
    • Fast Braces
    • Invisalign
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Patient FormBlue Tooth Dental2021-09-14T17:06:47+10:00
Name
Preferred Name
Date of Birth
Address

Emergency Contact

Are you in a Health Fund?
How did you hear about us?
Please tick if you have ever suffered OR are currently suffering from:
Have you had your COVID-19 vaccination?
Are you currently, or have you ever been a smoker?
Are you Pregnant?
Due Date
Do you have any kind of Prosthesis?
Are you taking any medications?
Have you had orthodontic treatment (Braces, clear aligners)?
Have you ever had any Facial Cosmetic Injectables and anti-Winkle Treatments?
Do you snore or suffer from sleep aponia?

Dear valued Blue Tooth Dental patients,

Blue Tooth Dental is not affiliated with any health fund, therefore a gap payment will be charged. Any discrepancies regarding your health cover needs to be discussed with your health fund, as we do not have access to any of your information regarding your cover. We take your health and wellbeing very seriously, so we aim to provide you with the best possible care using equipment and materials of a high standard. As courtesy to the treatment provided, we appreciate that all accounts be settled on the day of treatment.

Cancellation Policy

We require 24 hours notice for appointment cancellation/rescheduling or a $60 cancellation fee will be charged. Cancellation at short notice means that other patients who were unable to book in have un-necessarily missed out on appointment times.
Consent
Date

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Contact Us

Phone: (02) 9519 2691
Address: 134 - 146 Enmore Road, Newtown NSW 2042
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  • About Us
  • Patient Experience
    • FREE Offers
      • Free Take Home Kit
      • Free Wisdom Teeth Consultation
      • Free Dental Implant Consultation
    • Payment Plan
      • Payment Plan
      • AfterPay
    • Kids Dental Offers
      • Kid’s No Gap Check up and Clean
      • Child Dental Benefits Schedule
    • HICAPS Easyclaim
    • Sedation
      • Happy Gas
      • IV/Twilight Sedation
  • General Dentistry
    • Check-Up And Teeth Clean
    • Restoratives
    • Wisdom Teeth Surgery
    • Children’s Dentistry
    • Dental Implants
    • Root Canal Treatment
    • Dentures
  • Cosmetic Dentistry
    • Veneers
    • Teeth Whitening
    • Dental Jewellery
  • Orthodontic Treatment
    • Fast Braces
    • Invisalign
  • News
    • Blog
    • Gallery
  • Contact Us
    • Patient Form
Contact Us

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