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Continuum Oral Health Check-In

This short check-in helps us understand your oral health before your appointment. It takes about 3 minutes. Your answers are confidential and will be reviewed by Dr Sandhya Jaswal, Clinical Director.

Your name

Your email address

Your date of birth

Your GP (optional)

If you have a regular GP, you can tell us who they are. This is optional. We will only contact your GP if you give permission below and something in your answers needs urgent attention. Dr Sandhya Jaswal reviews and approves any letter before it is sent.

Your GP's full name

Your GP's practice name and suburb

Permission to contact your GP

If anything in my answers needs urgent attention, I give permission for Continuum to send a short letter to my GP.

Before we begin, four important questions. If any of the following apply to you right now, please stop and contact emergency services or Healthdirect before continuing.

Do you have pain, aching, or throbbing in your teeth, gums, or jaw right now?

A

Yes

B

No

Have you had a recent injury to your teeth, jaw, or face, for example a knock, fall, or blow?

A

Yes

B

No

Do you have swelling in your face, mouth, or neck?

A

Yes

B

No

Do you have any difficulty breathing, swallowing, or opening your mouth?

A

Yes

B

No