Form library · DEN-001
Dental new patient registration
Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.
Australian dental practices registering a new patient.
Contact details, an Australian health fund, and an emergency contact. There is no government logo and no claim that the form is approved by any agency.
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Dental new patient registration
Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.
Fields
Patient details
Name, date of birth, mobile and email.
Health fund
The Australian fund list used on the demo.
Emergency contact
Name and phone.
Signature
Signed on the phone.
Questions
Is this a government form?
No. This form does not ask for a Medicare number. It is not a government form, and it does not use a government logo or the Commonwealth Coat of Arms.
Where does the medical history go?
It goes on the dental medical history form. This form is only for registering a new patient.
State/Territory waivers
Waiver and consent rules differ between states and territories. Check the civil liability law where you operate, and get your own legal advice if you're unsure.