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Northland Prosthodontics - Northland Denture Specialist - Whangarei

Specialised prosthodontic treatments for patients throughout Northland. Talk to us about dentures, missing teeth, worn out teeth, gappy smiles needing cosmetic dentistry, veneers, crowns (caps), bridges and implant crowns.

Appointments (09) 4867778

c/o North Shore OMS, 08/3 Akoranga Drive, Northcote, Auckland
| Email Us | Meet Alan
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You are here: Home | Forms | Patient Medical Questionnaire

Patient Medical Questionnaire

A health questionnaire needs to be filled out before we can commence any treatment at Northland Prosthodontics, c/o Northshore Oral and Maxillo-facial Surgeons (NSOMS).

Although you have the option to click on the Medical Questionnaire below, complete and submit on line, there will still be a need to complete digitally the Medical Questionnaire on arrival at NSOMS. Please arrive 15 minutes prior to your appointed time to fill out the questionnaire with us.

  • Patient Details

  • (home)
  • (work)
  • (mobile)
  • DD slash MM slash YYYY
  • Medical Problems

    ln order to provide the best and safest dental treatment, your dentist needs to know of any medical problems which may affect your treatment.
  • Have you ever had any of the following (please tick yes or no):

    Cardiovascular:

  • Respiratory:

  • Other


  • Have you ever had contact with:

  • MM slash DD slash YYYY

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Dental Treatments

Why Implant Dentures?

Brian talks about how implant dentures changed his life.

ASK ALAN

More about Alan...

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Wow did I ever have a hang-up about my grubby teeth and people making fun of me for years ! Once Alan and Lesa did a make-over on me by taking out my rotten teeth and making me dentures, I now feel like a new man and not like a dinosaur! Alan and Lesa were very patient working with me and my tough mouth – in fact the whole team including Yvonne and Carol need a big vote of thanks. Eating peanuts is going to be more fun now – you guys have changed my life! Ken F

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Make an appointment

We're open Tuesdays/Wednesdays/Thursdays from 9.00am - 4:30pm and Fridays 9.00am – 12 noon.
Phone us on 09 486 7778 or 0800 676 670 and ask for Rachel.
An initial prosthodontic consultation is usually recommended at $420-450 to determine your treatment needs. Email Us Now

We are at North Shore Oral & Maxillofacial Surgeons, 08/3 Akoranga Drive, Northcote, Auckland and 3 Broadway, Newmarket, Auckland.

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NORTHLAND PROSTHODONTICS LTD. Ph: 09 486 7778.