nopen
Try it free

Form library · DEN-002

Dental medical history

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Rules differ by state; check yours.

Australian dental practices asking about conditions, medicines and allergies.

A short history the practice reviews. It asks about conditions, medicines, allergies, pregnancy, and medicines that affect bone. It is not a diagnosis and it is not a government health record.

Dental at nopen

Use as is

We add your logo and colours. No setup fee.

Use as is — no setup fee

Minor changes

Tell us what to change. We quote that edit.

Starting point

We build a new form from this brief.

Use as a starting point

nopen

Demo only, no real details

Dental medical history

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Tell us if any of these apply
Are you pregnant?
Do you take a medicine for bone density, or a related cancer treatment?

Fields

  • Conditions

    Heart, diabetes, asthma, bleeding and seizures, plus a free-text other.

  • Medicines

    What they take now, in their own words.

  • Allergies

    Medicines, latex and other reactions.

  • Pregnancy

    Yes or no.

  • Bone medicines

    Whether they take a medicine for bone density or a related cancer treatment.

Questions

Who should check the wording?

The practice, against its clinical rules and the health-records law in its state.

Does a yes answer block treatment?

No. It tells the practice to ask a follow-up question. The form does not decide treatment.

About these templates

These templates are examples only, to help you get started. They are general information, not legal, medical, clinical or professional advice, and they may not suit your business, your profession or your state or territory.

Before you use any template, you must review and adapt it, and have it checked where needed, so it fits your services, your professional body's rules, privacy and health records laws, and the law where you operate. This matters most for consent, waiver, privacy and minors' forms. You are responsible for the forms you use and the information you collect.

To the extent the law allows, Nopen gives no warranty that the templates are complete, current or fit for any purpose, and is not liable for loss arising from their use. Nothing here excludes, restricts or modifies any right or remedy you have under the Australian Consumer Law that cannot lawfully be excluded.

The templates are not endorsed by or connected with any government agency, including Services Australia, Medicare or the NDIA. Do not add government logos, the Commonwealth Coat of Arms or other official marks to them. Fields that refer to government numbers (such as a Medicare card number) are labels only.

Templates were last reviewed on 14 October 2026. Laws change, so check that a template is current before you rely on it.

Example template only. Not legal or clinical advice. Review and adapt before use. Not endorsed by any government agency. Last reviewed 14 October 2026.

Drafted 14 October 2026.