New Patient Form

To request an appointment with EDC please complete the information below and it will be sent through to our reception staff for processing.

This information, which will remain strictly private and confidential, will provide us with a better understanding of your dental and oral health needs as well as your medical history so that we can provide you a better service. We will not disclose patient's personal information.

If you have any questions regarding this form or to make an appointment by phone, please email us at info@emergencydentalcentre.com.au