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

30/08/2021

It’s important that we don’t sacrifice our dental health which is why we are still open for dental emergencies. We are accepting cases for:

  • broken teeth and fillings
  • facial swelling
  • wisdom tooth pain
  • dental abscess
  • crown and bridge dislodgement
  • gum pain and bleeding
  • orthodontic wire break

To make an appointment or if you have any queries please call 9690 6388.

Stay safe!

SMDG