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Welcome to Budi Dental!

Our team is really looking forward to meeting you and taking care of your dental health.

As a new patient, you will be required to complete a Medical History Form prior to your initial appointment. It is important for your dentist to know details about your medical history as these could affect the success of your dental treatment and how we can provide this treatment safely for you. All information supplied by you will be kept strictly confidential.

We ask that you arrive 10 minutes early to your first appointment to fill out a Medical History Form, alternatively you can fill out the form below.

Once we receive your completed form, one of our friendly receptionists will contact you to organise a suitable time for your initial appointment (if one has not already been scheduled).

New Patient Form





















Medical details and history





Do you have, or have you ever had, any of the medical conditions below?

Please view the list carefully and tick the boxes that apply.

Medical Conditions

Heart DisorderAsthmaHepatitis/HIVKidney DiseaseCancerTuberculosisArtificial JointSteroid TherapyIntellectual DisabilityHearing ImpairmentBone Disease / OsteoporosisHeart MurmurSinus TroubleLow Blood PressureLiver DiseaseLeukemiaEpilepsy/SeizuresHeart pacemakerExcessive BleedingNervous or Psychiatric ConditionContact with a blood-borne virusVisual ImpairmentMitral Valve ProlapseDiabetesHigh Blood PressureStrokeMarrow TransplantRadiation TherapyThyroid ConditionPhysical DisabilityStomach or Digestive ConditionArthritis/RheumatismBronchitis/Lung disease/Emphysema

Get in touch with our team

Budi Dental aims to make your dental experience fun and enjoyable
Find out how we can help you.