OHB Medical for Children aged 18 months to 17 years

  • Child & Parent Details

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  • Which location is managing your booking?
  • (if there is no 2nd parent/guardian, please fill as N/A)
  • e.g. another parent, health professional, google, social media, radio, billboard etc.

  • Health History

    This information is collected to understand your child’s growth, development and health.
    Please check any boxes that apply
  • If yes, please provide Specialist's name, Profession & name of practice
  • (please include vitamins/natural supplements)

  • Dental History

  • **Especially if any dental x-rays were previously taken, as Oral Health & Beyond will only take diagnostic images if clinically necessary.
    If clinically required, dental x-rays are an important part of diagnosing your child's dental health. Oral Health & Beyond uses very low dose radiation equipment. This will be discussed if needed, as your consent is required.

  • Myofunctional/Diet/Feeding History

  • Sleep & Developmental Questions

  • Acknowledgement

    I submit this medical form on behalf of my child & I understand that this information is correct to the best of my knowledge. I understand it will be held strictest confidence and only used to improve the quality of service my child receives.
    I understand I am financially responsible and that payment is due on the day of my child's appointment. *Health Funds - I understand that my health insurance & rebates received are the responsibility of my insurer and myself. *CDBS - I understand it is my responsibility to advise if my child is eligible for benefits, limits to available funds apply and that not all dental services are covered under this government incentive. I will sign the required CDBS consent form as required.
    Photos are routinely taken for dental/myofunctional, research & education purposes and in most cases these are for your child's dental records & kept on file only. Oral Health & Beyond does sometimes takes fun photos for use on social media, but will always ask your permission. I understand that if photos of my child are used, first name may be used but all other identifying information will be kept confidential. I do not expect compensation, financial or otherwise for the use of images.
    Oral Health & Beyond Collective requires your contact information, including email, for appointment purposes. From time to time, promotions, competitions, events may be emailed to you. Do you consent to receive marketing material from Oral Health & Beyond Collective. *You can unsubscribe from our mailing list at any time.
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