Medical History Form & SPDC Privacy Policy

Are you new to our clinic or haven't visited us in the last two years? If so, please take just a few minutes to fill out and print the following new patient / medical history form.

If you're an existing client, you can also use the form to update any changes to your personal details. It will save you the time and hassle of having to provide the information at your next appointment with Surfers Paradise Dental Centre (SPDC).

At SPDC we take your privacy very seriously. That’s why we’re asking you to print the new information sheet, fill it out and sign it, then bring it along with you to your next appointment.  Or you can download it into your own computer now for completion whenever you like.  It’s the surest way of safeguarding the security of your information.

To access the form, please click on the link below.  


New Patient / Medical History Form


Here at SPDC we respect your privacy and your personal information remains confidential at all times.

In order to provide you with the highest standard of dental care, SPDC is required to collect personal information from you.  This information covers basic details such as your name, address and telephone number.  It is also necessary for the dentist to obtain from you, details regarding your general health and past medical or surgical events. Without this general health picture, the treating dentist is unable to plan your care properly.


Naturally, some of this information is of a personal nature and some of it might be regarded as ‘sensitive’ and not the sort of information that you would wish to be unnecessarily disclosed to others.


At SPDC, we value the need to safeguard this information and, in accordance with the principles laid down in privacy legislation and the guidelines issued by the Australian Dental Association, we would like to assure you that:


  • This information will only be used by the treating dentist in order to deliver your care to the highest standards.
  • It will not be disclosed to those not associated with your treatment without your consent except as provided under the legislation and where we consider you would have a reasonable expectation of us to provide such information, for example if we refer you to a specialist practitioner, or if a laboratory is instructed to make a customised prosthesis for you.
  • We may also use parts of your health information for research purposes, in study groups, at seminars or on our web-site as this may provide benefits to other patients.  Should that happen, your personal identity will not be disclosed without your consent, to do so.
  • You may seek access to the information held about you and we will provide this access without undue delay. This access might be by inspection of your dental records at the time of appointment or by special access or copying of information at other times.
  • There will be no charge made for requesting this information but there may be fees levied to cover the costs associated with the processing of this request or the copying of information.
  • We will take reasonable steps to ensure at all times that the details we keep about you are accurate, complete and up-to-date.
  • We will take reasonable steps to protect this information from misuse or loss and from unauthorised access, modification or disclosure.
  • Our full  Privacy Policy may be Downloaded     or you may ask a member of our friendly reception team for a copy.
  • Our team at SPDC is trained to respect these principles at all times.


If you have any questions regarding the information we collect from you and hold in your dental records,

please do not hesitate to ask us. We are acting in your interests at all times.


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