051 879 592 [email protected]

Become A Patient

To become a patient of Christie Dental simply fill in the Medical & Dental Questionnaire below

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Medical & Dental Questionnaire

I Consent to this practice Collecting and maintaining a record of my PPSN for the purposes of verifying my eligibility for dental benefits and where appropriate and the submission of claims for payment.
I Consent to this practice Collecting and maintaining a record of my Medical Card for the purposes of verifying my eligibility for dental benefits and where appropriate and the submission of claims for payment.