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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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I am blown away by the amazing results of my crowns
How lucky I was to have found Alan and his trusty assistant Lesa, when I researched who would be the best cosmetic dentist for me. It’s not often anyone can say they enjoyed their dental appointments – but I can! Alan was so professional while at the same time sharing his sense of humour, both he and Lesa made me feel like I was their only patient. I am blown away by the amazing results of my crowns and am now boasting a great smile, enjoying smiling in photos for the first time! Thank you Alan and Lesa for your attention to detail and your concern for my comfort, please also pass on my thanks to the fantastic Lab Techs you work with.
Michelle D
More testimonials...

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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.