Health Questionnaire form


STEPS

1) Please download and print the form from the links below.

        LINKS, 3 PART FORM HERE:

        Form - Part 1
         Form - Part 2
         Form - Part 3

2)Fill out the form and scan or photograph the three parts.


3) Email us back to jake@totalhealthdentistry.co.nz attaching the completed Health Questionnaire form (the three parts).


For patients interested on have a tooth implant or tooth extraction procedure we recommend to read our Implant and Extraction notes .