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Dental Implants

Single Implants
Multiple Implants
Immediate Implants
Implant Bridge
All-On-4®

Cosmetic dentistry

Smile Makeover
Porcelain Veneers
Invisalign
Teeth Whitening
Digital Smile Design
Cosmetic Bonding

Straighten Your Teeth

Invisalign
Orthodontics

Restore Broken or Missing Teeth

All-On-4®
CEREC: Same Day Crown
Dental Crown & Dental Bridges
Dental Fillings
Dental Implants

Dentures
Tooth Restoration

Treat Gum or Bone Infection

Gum Treatment
Periodontal Treatment
Root Canal Treatment
Wisdom Teeth Removal

Preventative and General

General Examination and Hygiene
Children’s Dentistry
Dental Anxiety
TMJ
Sleep Dentistry
Emergency Dentistry

Before/Afters

Photo Gallery
Patient Journeys

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Video Blog
Articles

Locations

Sunbury
Bacchus Marsh
Gisborne
Diggers Rest
Melton
Dental Couture

FAQ

About

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Technology
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Our Team
Join Us

Contact Us

Prices

Price List
Payment Plans
My SuperCare
Afterpay
TLC



Dental House In Sunbury
Book Now   1800GENTLE

Services

Dental Implants

Single Implants
Multiple Implants
Immediate Implants
Implant Bridge
All-On-4®

Cosmetic dentistry

Smile Makeover
Porcelain Veneers
Invisalign
Teeth Whitening
Digital Smile Design
Cosmetic Bonding

Straighten Your Teeth

Invisalign
Orthodontics

Restore Broken or Missing Teeth

All-On-4®
CEREC: Same Day Crown
Dental Crown & Dental Bridges
Dental Fillings
Dental Implants

Dentures
Tooth Restoration

Treat Gum or Bone Infection

Gum Treatment
Periodontal Treatment
Root Canal Treatment
Wisdom Teeth Removal

Preventative and General

General Examination and Hygiene
Children’s Dentistry
Dental Anxiety
TMJ
Sleep Dentistry
Emergency Dentistry

Before/Afters

Photo Gallery
Patient Journeys

Blog

Video Blog
Articles

Locations

Sunbury
Bacchus Marsh
Gisborne
Diggers Rest
Melton
Dental House Studios

FAQ

About

Our Philosophy
Our Values
Technology
Our Dentists
Our Team
Join Us

Contact Us

Prices

Price List
Payment Plans
My SuperCare
Afterpay
TLC


Patient Questionnaire

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  2. Patient Questionnaire
DD slash MM slash YYYY
When was the last time you had a dental health checkup?

How often during the last year, have you had discomfort in the following parts of your mouth?

Very often

Fairly often

Hardly Ever

Never

Teeth
Gums
Tongue
Jaws
What was the main reason for your last visit to a dental practice?

Have you visited a dentist for the following in the past 12 months?

Yes

No

Don't Remember

Treatment for gum disease such as scaling and deep cleaning
Treatment for teeth ever becoming loose without an injury
Emergency Treatment
Treatment for any cavities in your teeth
If you were unable to get dental health care, what was the reason?
How often during the last year, have you been self-conscious or embarrassed because of your dental smile or concerns?

How satisfied are you with the health of the following?

Satisfied

Not satisfied

Teeth
Gums
Tongue
Jaws
Overall
Front Office Coordinator Rhiannon - Sunbury Dental House

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