Downloadable Forms

We have a selection of introduction packs which are able for download.

Medical History

Medical History Form Or you can complete this form online here.

Patient Authority to Release & Obtain Dental & Medical Records

Want to know more about our gum disease treatments? Or why maintaining healthy gums is so important? Download our FREE guide here!

Your Guide to Gum Disease

Download The Guide

Want to know more about our gum disease treatments? Or why maintaining healthy gums is so important? Download our FREE guide here!

Your Guide to Gum Disease


                <div class='gf_browser_gecko gform_wrapper contact-forms_wrapper gplaceholder_wrapper' id='gform_wrapper_11' ><a id='gf_11' class='gform_anchor' ></a><form method='post' enctype='multipart/form-data' target='gform_ajax_frame_11' id='gform_11' class='contact-forms gplaceholder' action='/downloadable-forms/#gf_11'>
                        <div class='gform_body'><ul id='gform_fields_11' class='gform_fields top_label form_sublabel_below description_below'><li id='field_11_10' class='gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_11_10' >Your Name<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_11_10' type='text' value='' class='large'  tabindex='50'  placeholder='Your Name *' aria-required="true" aria-invalid="false" /></div></li><li id='field_11_3' class='gfield gfield_contains_required field_sublabel_below field_description_below hidden_label gfield_visibility_visible' ><label class='gfield_label' for='input_11_3' >Your Email<span class='gfield_required'>*</span></label><div class='ginput_container ginput_container_email'>
                            <input name='input_3' id='input_11_3' type='text' value='' class='large' tabindex='51'   placeholder='Your Email *' aria-required="true" aria-invalid="false"/>
                        </div></li><li id='field_11_17' class='gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible' ><input name='input_17' id='input_11_17' type='hidden' class='gform_hidden'  aria-invalid="false" value='1245' /></li><li id='field_11_15' class='gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible' ><input name='input_15' id='input_11_15' type='hidden' class='gform_hidden'  aria-invalid="false" value='Gum Disease Guide' /></li><li id='field_11_16' class='gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible' ><input name='input_16' id='input_11_16' type='hidden' class='gform_hidden'  aria-invalid="false" value='' /></li><li id='field_11_18' class='gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible' ><input name='input_18' id='input_11_18' type='hidden' class='gform_hidden'  aria-invalid="false" value='' /></li><li id='field_11_20' class='gfield gform_hidden field_sublabel_below field_description_below gfield_visibility_visible' ><input name='input_20' id='input_11_20' type='hidden' class='gform_hidden'  aria-invalid="false" value='' /></li><li id='field_11_21' class='gfield gform_validation_container field_sublabel_below field_description_below gfield_visibility_visible' ><label class='gfield_label' for='input_11_21' >Phone</label><div class='ginput_container'><input name='input_21' id='input_11_21' type='text' value='' /></div><div class='gfield_description'>This field is for validation purposes and should be left unchanged.</div></li>
                            </ul></div>
        <div class='gform_footer top_label'> 
		<div class="section-button">
	        <button type="submit" id="gform_submit_button_11" class="btn btn-primary">
		        Download now
			</button>
		</div>
     <input type='hidden' name='gform_ajax' value='form_id=11&amp;title=&amp;description=&amp;tabindex=50' />
            <input type='hidden' class='gform_hidden' name='is_submit_11' value='1' />
            <input type='hidden' class='gform_hidden' name='gform_submit' value='11' />
            
            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' />
            <input type='hidden' class='gform_hidden' name='state_11' value='WyJbXSIsImU0MWFmM2RmNDIwMmQ2NmYxOWE4ZDM2OTQyNmY4ZGY0Il0=' />
            <input type='hidden' class='gform_hidden' name='gform_target_page_number_11' id='gform_target_page_number_11' value='0' />
            <input type='hidden' class='gform_hidden' name='gform_source_page_number_11' id='gform_source_page_number_11' value='1' />
            <input type='hidden' name='gform_field_values' value='ebook_id=1245&amp;ebook_active_campaign_tag=Gum+Disease+Guide' />
            
        </div>
                        </form>
                        </div>
                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_11' id='gform_ajax_frame_11'>This iframe contains the logic required to handle Ajax powered Gravity Forms.</iframe>
                <script type='text/javascript'>jQuery(document).ready(function($){gformInitSpinner( 11, 'https://pacificperio.com.au/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery('#gform_ajax_frame_11').load( function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_11');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_11').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;if(is_form){jQuery('#gform_wrapper_11').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_11').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_11').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_11').offset().top); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_11').val();gformInitSpinner( 11, 'https://pacificperio.com.au/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery(document).trigger('gform_page_loaded', [11, current_page]);window['gf_submitting_11'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_11').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_11').offset().top);jQuery(document).trigger('gform_confirmation_loaded', [11]);window['gf_submitting_11'] = false;}, 50);}else{jQuery('#gform_11').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [11, current_page]);} );} );</script>

In best interests of patients, staff and families we have ceased regular care.

We will contact all patients with upcoming appointments to reschedule.

Fortunately periodontal & implants emergencies are rare. For advice please contact:

Dr. Adrian Hoffman on 0417102710 / adrian@pacificperio.com.au

TEMPORARY CLOSURE