265 Park Street South Melbourne

Victoria 3205 Australia

T 61 3 9690 6388

info@southmelbournedental.com.au

Monday to Thursday 9.00 am – 6.00 pm

Friday 9.00 am – 5.00 pm

Saturday 9.00 am – 1.00 pm

265 Park Street South Melbourne

Victoria 3205 Australia

T 61 3 9690 6388

info@southmelbournedental.com.au

Monday to Thursday 9.00 am – 6.00 pm

Friday 9.00 am – 5.00 pm

Saturday 9.00 am – 1.00 pm

If you prefer to fill the form offline, click here – don’t forget to print it out and bring it with you on your first appointment.

New patient form

Step 1 of 3

  • Patient details
  • First name
  • Surname
  • Title (e.g. Mr/Mrs/Other)
  • Date of birth (DD/MM/YYYY)

  • Address
  • Suburb
  • Postcode
  • Phone
  • Mobile
  • Email
  • Fax

  • Name of person responsible for fees
  • Relationship

  • Emergency contact
  • Relationship
  • Phone

  • Medical doctor
  • Address
  • Suburb
  • Postcode

18/1/24

Happy new year!

We’re looking forward to a great year ahead with some major expansion renovations planned in the latter part of the year.

We also have new dentists Dr Nathan Wolf and Dr Alex Nguyen join us for Saturdays. To arrange an appointment please call 9690 6388 or book online.

See you soon!

SMDG