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BLACKBURN DENTAL GROUP
23 Blackburn Road
Blackburn
Victoria 3130 Australia
Tel: (03) 9878 1411
Fax: (03) 9894 1997
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PATIENT HISTORY
Welcome to Our Practice
As a new patient, we offer
these forms - Patient History
& Transfer of Records for
completion prior to your visit.
Please take your time to answer
the Patient History questions
as completely as possible. The
information is necessary to
enable us to give maximum consideration
to your time and feelings. Details
of your health are especially
important when planning any
treatment. Previous records
are also of benefit to keep
on file
These forms can be downloaded
via the links below for you
to bring to your first appointment
or fax to us prior on [03] 9894
1997


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Dentists:Dr
Anthony D. Robertson B.D.Sc.,L.D.S.; Dr
Jennifer L. Levecke B.D.Sc.; Dr William
Levecke B.D.Sc.; Dr Wynne Yip B.D.Sc.
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