Blacktown : 9622 3333 | blacktown@winningsmilesdentists.com.au
Denham Court : 9157 1000 | denhamcourt@winningsmilesdentists.com.au

New Patient Registration

  • General Questions

  • You can select multiple option...
  • General Practitioner Details

  • Since Last Visit Questions

  • You can select multiple option...
  • Consent for treatment by patient

    I hereby authorise the dentist or designated team member to take x-rays, study models, photographs, and other diagnostic aids deem appropriate by the dentist to make a thorough diagnosis. Upon such diagnosis, I authorise the dentist to perform all recommended treatment mutually agreed upon by me and to employ such assistance as required to provide proper care. I agree to the use of anaesthetics, sedatives and other medication as necessary. I fully understand that using anaesthetic agents embodies certain risks. I understand I can ask for a complete recital of any possible complications. I agree to be responsible for payment of all services rendered on my behalf and on behalf of my dependants. I understand that payment is due at the time of service unless other arrangements have been made.

SiteLock