Medical History Form for new and returning patients

Please review the below Privacy Policy to Continue

In accordance with the Victorian Records act 2001 and Privacy act.

Our Practice respects you right to privacy. We realise that it is important that you understand the purpose for which we collect details about your health, as well as how this information is used at our practice and to whom this information might be disclosed.

The policy of our practice is to follow these procedures:

1. The information collected will be used for the purpose of providing the treatment to you. Personal information such as your name, address and insurance details will be used for the purpose of addressing accounts to you, as well as processing payments and writing to you about our services and issues affecting your treatment.

2. We may disclose your health information to other health professionals, or require it from them if, in our judgement, that is necessary in the context of your treatment. In that even, disclosure of your personal details will be minimised wherever possible.

3. We may also use parts of your health information for research purposes, in study groups or at seminars as this may provide benefit to other patients. Should that happen, your personal identity would not be disclosed without your consent to do so.

4. Your medical history, treatment records, x-rays and any other material relevant to your treatment will be kept here. You may inspect or request copies of our records of your treatment at any time, or seek an explanation from the dentist. Statutory fees will apply in relation to the types of access you seek. If you request an explanation of our records or a written summary, our usual fees apply to these services.

5. If any of the information we have about you is inaccurate, you may ask us to alter the records accordingly.

You can otherwise rest assured that your health information will be treated with the utmost confidentiality. Disclosure will not be made to any person not involved in either your treatment or the administration of this practice, without your prior consent. If you have any queries or concerns about our handling of your health information, please do not hesitate to raise these concerns with our practice.

If you have any queries please call us on 03 8256 9911 or send an email to