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

Welcome!

Due to heavy patient bookings online appointments are currently unavailable. Please call 9690 6388 to schedule your appointment.

See you soon!

SMDG