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COMMUNITY
AND FAMILY FOCUS |
TECHNOLOGICALLY
ADVANCED |
STRONG IN EDUCATION
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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
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.
You can complete your Patient
History Sheet in either of two
ways:
1. You can download the Patient
History Sheet, print it, complete
it and bring it with you to
your first appointment.
.
2. You can download the Patient
History Sheet, print it, complete
it and fax it back to us on
(03) 98941997.
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Principals:Dr
Anthony D. Robertson B.D.Sc.,L.D.S.; Dr
Jennifer L. Levecke B.D.Sc.; Dr William
Levecke B.D.Sc.
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