Congratulations $55 Credit is Yours

Claim another *$55 Credit - Complete the Dental Questionnaire Below

Please enable JavaScript in your browser to complete this form.

PLEASE NOTE!

1. Questions appear under the answers.

2. The questionnaire is under live construction and testing.

3. If the answers do not make sense to you, just select any answer, and the dentist will review and update it during your consultation.

Regards Dr Denver Maloney

COMPLETED BY:
Who completed this form?

Patient Details

We are committed to maintaining patient confidentiality, so please do not provide the full name of the patient.
What is the patient's age in years?
This email is used to send you essential information about the patient's dental care. We may also use it to refer specialists as needed.
PATIENT STATUS:
APPOINTMENT BOOKED:
How did you set your dental appointment?
REASON FOR APPOINTMENT:
Select the procedure you want at your dental appointment. Select all that apply.

Dental Status

Let's get some general details about oral health.

ORAL CONDITION:
Which of the above do you have? Select all that apply.

Dental Insurance & Government Schemes

Let's get details about private health insurance and government-funded dental care schemes.

GOVERNMENT-FUNDING:
Does the patient qualify for a government-funded dental care scheme?

Private Health Insurance

MOBILITY AID:
Are you using a mobility aid?
minor oral surgery

OPG Radiograph General Screen - All Patients

lat ceph radiograph

Lateral Cephalogram for Orthodontic Consultation

Thank You!

Sharing your dental history enables the dentist to focus on your unique needs and experiences while providing dental care that meets your unique needs.

See you soon,

Riverina Dental Albury Team

* Earn Another $55 Credit- LEARN MORE

Completing the dental questionnaire enables Dr Maloney to save more time during your first visit, allowing us to focus on formulating a customised dental care plan to meet your unique needs and circumstances.

Your thoroughness, attention to detail, and commitment to providing comprehensive medical information have saved us time during your initial consultation. Taking the time to complete a dental questionnaire will save us even more time, so we’re offering you a further $55 credit for completing the form below.

Your proactive approach to providing this vital information demonstrates your dedication to your dental health, and we are grateful for your cooperation.

Rest assured that the information you have provided will be handled with the utmost confidentiality and professionalism, in line with our commitment to safeguarding patient privacy. We look forward to using the information you have shared to provide you with the highest standard of dental care.

Please do not hesitate to contact us with any questions or further assistance. Your feedback is always welcome; we support you in every step of your dental journey.

Warm regards,
Dr Denver Maloney, BDS
Riverina Dental Albury

*These credits do not apply to Medicare Bulk Billing and Health Fund Members’ Billing Programmes