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051 879 592

Become A Patient

IMPORTANT NOTICE BEFORE BOOKING AN APPOINTMENT

***Attention Non-English Speaking Patients***
If you are unable to communicate effectively in the English language, please bring someone with you who can communicate with us on your behalf when attending your dental appointment

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

Step 1/5:
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Medical & Dental Questionnaire

Please complete this form in English only

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.