New
Patient
Information

At Richmond Village Dental your comfort, confidence, and positive dental experience are paramount to all of our staff members.

Once you’ve made an appointment with us, we will email some vital information to help prepare you for your first appointment, including what to expect. If you still have further questions, don’t hesitate to call and clarify. This email will also include a copy of our Medical History Form, which you can fill in before your appointment and email it through. Alternatively, if you could arrive 10 minutes before your appointment time to complete the for that would be greatly appreciated.

If you have records (such as x-rays) from your previous dentist you would like to discuss with the dentist, please let us know to arrange for them to be transferred before your appointment. This can sometimes take a couple of days to organise.

We hope you have an enjoyable first experience and welcome feedback if we can do anything to make your dental experience more comfortable.

What are my rights as a patient?

Please see the NZ HDC.

 

 

Dental Health History Form

This confidential questionnaire provides the information your dentist needs for your dental care:

    Is another member of your family a patient at our office?

     

     

    Are you currently taking any medications?

     

    Does your jaw click or hurt?

    Do you smoke or vape?

    Is your snoring a problem for you or your partner?

    Do you wake feeling unrefreshed?

    Do you feel you grind your teeth?

    Do you have occasional bad breath?

    Have you ever had orthodontic treatment?

    Do your gums ever bleed when you brush your teeth?

    Do you wear a night guard?

    Do you experience sensitivity to hot/cold?

    Have you ever had gum disease?

    Does your mouth often feel dry?

    Are you fearful of dental treatment?

     



    Are you pregnant?

     

    Consent for treatment

    I hereby authorise the dentist or designated team to take x-rays, study models, photographs, and other diagnostic aids deemed appropriate by the dentist to make a thorough diagnosis. Upon such diagnosis, I authorise the dentist to perform all recommended treatment mutually agreed upon by me and to employ such assistance as required to provide proper care. I agree to the use of anaesthetics’, and other medication as necessary. I fully understand that using anaesthetic agents embodies certain risks. I understand I can ask for a complete recital of any possible complications. I agree to be responsible for payment of all services rendered on my behalf and on behalf of my dependents. I understand that payment is due at the time of service unless other arrangements have been made. I authorise that this data may be reviewed by team members of the dental practice.

    Declaration