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1. Arrange your appointment
Book online or call 04 564 1670 if you need help choosing a visit. Completing an enrolment form does not confirm an appointment.
2. Get ready for enrolment
The existing Wainui Dental patient questionnaire asks for contact details, dental concerns and medical history. In this prototype, every field is disabled and nothing is sent.
Enrolment preview
Demonstration only. Fields are disabled. Please do not enter personal or health information.
Contact and appointment information
Preferred title, name, address, phone numbers, date of birth, emergency contact, GP, occupation, previous dentist, last dental visit, email and NHI if known.
Dental concerns and medical history
Concerns about chewing, fillings, pain, sensitivity, jaw discomfort, appearance, dry mouth, gums and grinding. The clinic questionnaire also asks about medical conditions, allergies, medicines and precautions relevant to care.
Declarations on the current form
The live questionnaire includes medical accuracy, health and safety, cancellation and payment declarations. These are retained in the source snapshot for clinic review. This preview does not ask you to accept terms or upload medication information.
3. Talk through your care
At your appointment, discuss your concerns and any questions about costs before treatment proceeds.