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Smile Group

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(03) 9132 0121 Patient form

Confidential patient information

Oral Health
Consent Form

Help our clinical team prepare safe, personalised dental care for your child.

Patient intake · Consent

Complete your child's details

Your answers help our clinicians prepare safe and appropriate care.

5–7 minutes

Secure & private

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Child

01 / 06

1Child
2Guardian
3Health
4Medicare
5Consent
6Review

Child's Information

Please provide your child's basic information.

Title *First Name *Middle Name

Last Name *Date of Birth *

Gender *

Step 1 of 6

Personal Information

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Australian Smile Group is committed to delivering premium dental healthcare services across Australia. Our experienced team combines advanced technology with compassionate care.

Dentists accredited by the Dental Board of Australia

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Contact

(03) 9132 0121 info@australiansmilegroup.com.au

21 Amaroo Cct, Bacchus Marsh, Victoria 3340, Australia

Mon–Fri: 8:00 AM–6:00 PM

Saturday: 9:00 AM–2:00 PM

Sunday: Closed

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