Contact Pain Free Dentist Sydney

Call our Dulwich Hill dental clinic on (02) 9558 8988. Contact Pain Free Dentist Sydney for general family dental, cosmetic dentistry, implants, TMJ and emergency.

For any questions, tips, information, consultations or more, please send us a message below, send us an email info@painfreedentistsydney.com.au or give us a call. If it is an after hours emergency, please call us directly.

You can also book appointments by clicking on the button below

New Form

Name

First Name

Last Name

Email Address

Phone

Message

Reason of Visit

Preferred Day and Time for Appointment

Pain freE dentist SYDNEY

Suite 1a, 570 New Canterbury Road

Dulwich Hill

(02) 9558 8988

Email: info@painfreedentistsydney.com.au

LOCATION AND Parking

Free Parking is available at the Dulwich Hill Clinic on Garnet Street and Duntroon Street, Hurlstone Park.

Located In Sydney's Inner West, the Pain Free Dentist Clinic is most convenient to Ashbury, Summer Hill, Hurlstone Park, Marrickville, Lewisham, Earlwood, Newtown, Petersham, Alexandria, Rozelle, Balmain, Annandale, Chatswood and Canterbury.

New Patient Questionnaire

To help us give you the best treatment in the most convenient way, our quick questionnaire will assist us in identifying the best course of action.

Questionnaire

Medical Details

Full Name

First Name

Last Name

Date Of Birth

MM

DD

YYYY

Address

Phone

(###)

###

####

Email Address

Preferred Contact Method

Occupation

Healthfund

Healthfund Name

Healthfund Number

Medicare Number

Checkup Reminder

6 Months

12 Months

Never

Other Illnesses?

Are you taking any medications?

Are you currently, or have a history of taking medication containing Bisphosphonate?

Have you been hospitalised recently?

If Yes, please explain why?

Are you allergic to penicillin?

Any other allergies?

Are you pregnant?

Have you ever had BOTOX or Fillers done?

if yes, please write the amount of units used

Dental History

Please describe what you would like to achieve from your visit today?

When was the last time you visited the dentist?

MM

DD

YYYY

Are you concerned with: (tick as many as you think applies to you)

Existing crowns, bridges or dentures

Ability to eat

Gaps between your teeth

Missing teeth

Crooked teeth Silver fillings (amalgam)

Previous dental treatment

Wisdom teeth pain

Smile makeover

Do you want to discuss whitening your teeth with us?

Pain Free Dentist Sydney do have a cancellation policy which requires at least 24hr notice so that others can be fitted in when you cannot attend. As we are a busy practice and we like to ensure that all emergencies are seen on the day, we appreciate 24 hr notice. Unfortunately you will attract a cancellation fee (a percentage of your treatment service of the day) if you do not provide us a 24 hr notice.