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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






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.


www.blackburndental.com.au