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Welcome to Cosmetic & Laser Dentistry Centre

So that we may provide you with the best possible care, please complete our medical/dental history form. Please note that all information is confidential and stored securely.


Note: If you are having difficulties with our online form, you can always complete a paper-based version when you attend the centre instead, but please allow 15 minutes ahead of your appointment time.

Personal Details

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Contact Details

Follow us @cldc_dental and @dryvonneking

Health Insurance

Billing

Next of Kin / Emergency Contact

In case of an emergency, who should we contact?