• First Visit
    • Getting Here
    • Registration Form
    • FAQ
  • Wisdom tooth
    • Wisdom Teeth - Are We Wiser Without Them?
    • Surgery After-Care
  • Root canal treatment
    • Why is Root Canal Treatment necessary?
    • After Root Canal Treatment
    • Causes of Root Canal Treatment failure
  • Preventive dentistry
    • Professional Oral Hygiene Maintenance and Gum Treatment
    • Fissure Sealants
    • Dental Abrasions and Cracks
    • Why Regular Checkups?
    • Oral health in pregnancy
    • Children's Dentistry
    • Age Changes of the Mouth
  • Restoring missing teeth
    • Options for broken teeth
    • Implants
    • Dental Bridges
    • Dentures
  • Tooth Whitening
    • Options for whiter smile
    • Teeth Whitening
  • Orthodontic (Braces)
    • Types of Braces Available (Orthodontic appliances)
    • Are braces right for you?
    • During Orthodontics (Braces)
    • After Braces
  • Patient Resources
    • Medisave
    • Post Treatment Instructions >
      • After a Dental Extraction
      • After a Filling/Crown is placed >
        • Permanent restoration
      • After Care of Crowns and Bridges
      • After a Dental Implant
      • After a Root Canal Treatment
      • After a Teeth Whitening
      • Denture After Care
      • Using and caring for a Bite Splint
Implants, Wisdom tooth surgery, Root Canal treatment, Crowns, Emergencies
Office: +65 6222 7075 (Voice only)
Emergency: +65 9671 1096 (Voice/SMS/Whatsapp)
Email: drhcleong@leongdental.com.sg
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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
    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
    Please indicate how you came to know of our office

    Patient Contact Information
    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.

    Emergency Contact Information
    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.

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

    Please briefly state the nature of the condition

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

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

    Dental History
    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. 
Submit Form
Normal Hours : Monday to Friday 9am to 7pm, Saturday 9am to 6pm

Contact : +65 6222 7075 (Voice)   
Email : drhcleong@leongdental.com.sg 

Emergency : +65 96711096  (Voice/SMS/Whatsapp)


Wisdom tooth
Endodontics
Orthodontics
Preventive
Restorative
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8 Eu Tong Sen Street #20-86 Clarke Quay Central (Office 2) Singapore 059818 (find on Maps)

© 2017 All Rights Reserved. Dr H C Leong Dental Surgeon LLP. UEN: T08LL1404J ​
​All information here is general in nature, is covers common situations. It is not possible to cover all possible situations and should not be used as a substitute for specific professional advice on your specific situation.