Patient Health History Questionnaire

Patient Information


Have you had any of the following?


Questions for Female Patients


Next of kin details


Details of the Parent/Guardian/Caregiver if patient is UNDER 16 YEARS OF AGE


Due to Covid 19 and the rise alert level 4 Anglesea OMS is closed until further notice.

If is an emergency situation, please email reception@anglcoms.co.nz and we will do our best to assist you.

Dental Council and the Ministry of Health advises all non-essential and elective dental services, particularly those generating aerosol, should be suspended immediately to reduce the risk of community spread, including to yourself, your staff and your patients.

Sorry for any inconvenience caused.

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