Bookings

Child's name

First Name

Last Name

Child's date of birth

Child's gender

Next of kin / contact

First Name

Last Name

Relationship of next of kin to child

Next of kin contact number

Home address

Next of kin email address

What questions do you have about your child's teeth?

What is your child's medical history?

Has your child been referred to us by their general dentist or oral health therapist? If so, which clinic?

Have any dental x-rays been taken in the last 6 months?

If so, please enter the date of the most recent x-rays

Preferred clinic location

Ascot Vale (all enquiries)

Albert Park (referral required)