For your comfort: Many people are still nervous about coming to the dentist. Whilst the improvements in techniques and anaesthetics have helped most people, you may still be apprehensive and wish us to take extra measures for your comfort. Please indicate your present level of apprehension (0= completely at ease, 10= petrified)

Are you aware of any of the following oral symptoms?

Dr Hoffman and staff do expect and appreciate you keeping your agreed appointment. If breaking your appointment becomes unavoidable, the more notice you provide the better, as this enables us to reschedule other patients and avoid highly trained staff and equipment sitting idle. Consequently, we require one week notice, or 48 hours as an absolute minimum. If we receive less than 48 hours notice, a cancellation fee of $150.00 will apply.

I acknowledge I have filled in this form to the best of my knowledge and ability, as honestly and correctly as possible.