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056 776 2329

Become A Patient

IMPORTANT NOTICE BEFORE BOOKING AN APPOINTMENT

***Attention Non-English Speaking Patients***
If you are unable to communicate effectively in English, it’s important that you bring someone along with you to your appointment who can speak English on your behalf.

Failure to do so may result in the need to cancel or reschedule your appointment.

To become a patient of Christie Dental Kilkenny simply fill in the Medical & Dental Questionnaire below

Step 1/5:

Medical & Dental Questionnaire

Please complete this form in English only

*For mobile devices, tap the year on top left of popup calendar to select DOB year
I Consent to this practice Collecting and maintaining a record of my PPSN for the purposes of verifying my eligibility for dental benefits and where appropriate and the submission of claims for payment.
I Consent to this practice Collecting and maintaining a record of my Medical Card for the purposes of verifying my eligibility for dental benefits and where appropriate and the submission of claims for payment.