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Singapore River Boat Quay night panorama

Registration / Medical History 

If you are a new patient coming to our office for the first time, we suggest that you enter your information below and submit the form. This will speed up registration procedures during your visit.

To our current patients, you can also inform us of any changes in your health status and personal information using this form without having to come to our office personally. You do need to fill out the entire form however, so if you are visiting us soon it may be easier to inform our staff of the changes during your visit.

Patient Personal Information
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Please give us the number of the same document in which your Full Name is indicated. If you are filling this form outside of our office, please bring this document with you when you come for your appointment

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Patient Gender

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Please indicate how you came to know of our office

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Patient Contact Information
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Please give us a personal email address that you will check regularly but is private. We use this email address to communicate with you and, on occasion, there may be personal information in the email.

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Emergency Contact Information
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While it is highly unlikely, it is possible that a medical or other emergency might leave you temporarily incapacitated. Please provide us with the contact details of a responsible adult we can communicate with in such an unlikely event.

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Health History
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Please indicate the nature of the condition and how you have been advised that it affects surgery/dental procedures

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Please briefly state the nature of the condition

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Do you have any allergies? (check all that apply)

Allergy information is very important for your safety. Please be as precise as possible

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please indicate frequency of tobacco usage/alcohol consumption or indicate the diet restriction

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Do you currently or in the last 6 months experience any of the following conditions? (check all that apply)

Dental History
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The information you have provided is kept strictly confidential and is necessary to enable us to provide you with the best care possible. If there is any relevant information you might not be comfortable to supply in this form please update our staff during your visit. 

Please note that by clicking "submit" below you are certifying that the information you have provided is accurate to the best of your knowledge.