Children's medical form

Field marked with * is required

Medical






Dental



Have any Permanent Teeth...

Has your child ever had Speech Therapy?

Have your child any recent rapid growth?

THANK YOU FOR PROVIDING US WITH THIS INFORMATION

If you subsequently develop any illness please keep us informed.

PERSON OR PERSONS RESPONSIBLE FOR THE ACCOUNT:

Address

By clicking submit, you are agreeing to our privacy policy

Book an orthodontic consultation

  • No-obligation meeting to discuss your options
  • Meet with one of our Treatment Coordinators
  • Find out about our payment plans

By clicking submit, you are agreeing to our privacy policy

Australian Dental Association

Royal Australian College of Dental Surgeons

Damon Smile

Australian Society of Orthodontists

Invisalign

Insignia

Ipswich Orthodontics

13 South Street
Ipswich
QLD 4305

07 3812 0865

Contact us