Dental new patient form
Collects contact details, dental history, anxiety level and the reason for the visit, with urgent pain routed for a same-day call.
About 4 min to complete. dental, new patient, clinic.
Use this templateQuestions in this template
- Full name
- Date of birth
- Mobile number
- Why are you coming in?
- How strong is the pain right now?
- When did you last see a dentist?
- Which of these apply to you?
- How nervous are you about dental visits?
- Please list any medicines or allergies we should know about.
- Consent
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Welcome to the practice.
A few questions now means a shorter wait at your first appointment. For a dental emergency, call the practice directly.