No cost and no-obligation
Come and see us for a no-obligation meeting to discuss your Invisalign treatment.
*Charge for photos and x-rays may apply.
Consultations with one of our Specialist Orthodontists are $200, inclusive of digital x-rays. Please call us on (07) 4951 4100 or request online to arrange a consultation.
Kindly fill in form for your Medical history or download our form below.
Fields marked * are required.
Heart disease/Heart Murmur
High/Low blood pressure
Asthma- Mild, Moderate, Severe
Any blood disorder
Joint problems /replacement
Disorder of the stomach, bowel or digestive system
Cancer/Tumors (Benign/ Malignant)
Please note that we only treat you according to the information you have provided for us.
The Privacy Act of December 21, 2001 states that we must have consent to collect personal information about you. Please read this information carefully and sign, where indicated, below.
This dental practice collects information from you for the primary purpose of providing quality dental care. We require you to provide us with your personal details and a full medical history so that we may properly assess, diagnose, treat and be proactive in your dental care needs. This means we will use the information you provide in the following ways:
I understand that I am not obliged to provide any information requested of me, but that my failure to do so might compromise the quality of the health care and treatment given to me.
I am aware of my right to access the information collected about me, except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances.
I understand that if my information is to be used for any other purpose other than set out above, my further consent will be obtained.
I consent to the handling of my information by this practice for the purposes set out above, subject to any limitations on access or disclosure that I notify this practice of. This consent is valid indefinitely.
Please sign here:
Level 2, 56 Gordon Street, Mackay, QLD 4740
(07) 4951 4100
Directions & opening times