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Pre-Oral Health Appointment — Continuum Teletherapy and Allied Health

This form helps your clinician prepare for your upcoming oral health appointment. It takes about 4 minutes to complete. If something doesn't apply to you, write 'none' or leave it blank — your clinician can discuss anything else in your appointment.

Medical context

A brief picture of your overall health helps us provide safe and appropriate care.

Do you have a regular GP?

Do you have a regular GP?
A
B
C

Relevant diagnoses or health conditions

Current medications

Allergies

GP health summary

All patients are asked to provide a current GP health summary so we can review relevant diagnoses, medications, allergies, and other important health information before care begins.

Have you uploaded a current GP health summary?

Have you uploaded a current GP health summary?
A
B
C
D

Do you authorise Continuum to request a brief health summary from your GP if needed?

Do you authorise Continuum to request a brief health summary from your GP if needed?
A
B

Oral health screening

These questions help your clinician understand your current oral health and what to focus on during your appointment.

When was your last dental visit?

Current oral health concerns

Current oral health concerns

Is help needed with toothbrushing?

Is help needed with toothbrushing?
A
B
C

How is oral health affecting daily life? (optional)

How do you feel about dental treatment generally?

1 = Completely comfortable 5 = Extremely anxious
How do you feel about dental treatment generally?
Completely comfortableExtremely anxious