Online New Patient Form | Robina Town Dental

We offer interest free payment plans. Click here to learn more.

We offer interest free payment plans. Click here to learn more.

New Patient Form

At Robina Town Dental we strive to provide you with the highest possible care. To do this we need to collect personal information from you that include contact details and matters pertaining to your general health, both past and present. Without this information it is difficult for your dentist or hygienist to plan your care properly.

Download the PDF version from here and bring your completed form to your appointment or you can fill it out upon arriving at our practice in just a few minutes before your appointment.

Click here to view our privacy policy.

$150 New Patient Smile Package

This package includes 1 clinical exam, 2 intra-oral radiographs and an oral cancer screening for at risk patients.

$195 New Patient Professional Clean

Your Professional Clean includes 1 x scale and clean with a hygienist. Book an appointment with Robina Town Dental today.

Patient Satisfaction Survey

We’d love to hear how your experience was at Robina Town Dental and any feedback to help improve your experience. This survey is completely confidential.

We'll Keep You Smiling

Robina Town Dental is now part of the Bupa Members First Ultimate network. This means we can offer even more benefits to our Bupa members.

Our Services

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Call us on 07 5575 9100