About 5 minutes · saved on this device as you go

New patient registration

Complete your registration online before your first visit and skip the clipboard. You’ll get a printable PDF at the end. Not for emergencies: call (08) 9330 7115.

Your answers are saved only in this browser on this device until you finish.

Before you start: how we handle your information

Advanced Dental Healthcare Pty Ltd (trading as Myaree Dental & Professional Centre) is collecting the information on this form, including health information, so our dentists can assess and treat you safely, keep your dental record, contact you about your care, and process Medicare, CDBS, DVA and health fund claims.

It's your choice, but if your health information is missing or inaccurate, we may not be able to treat you safely. Health fund and Medicare details are optional here. You can show your cards at the front desk instead.
Where it goes: your answers are sent securely (TLS) to Zoho Forms and stored in Zoho's Australian data centre (Sydney/Melbourne) under Form Encryption, so only authorised staff with a private access code can open them. Only your name, date of birth and contact details are copied into our Zoho CRM (also in Australia) so we can contact you. Your health answers, signature and PDF copy are not. Our mailbox, customercare@myareedental.com, receives only a "New registration received – view in Zoho" alert, with no patient details. Staff open your form in Zoho and add it to your dental record. While you type, answers are saved only on this device for up to 30 days. Press "Clear my data" to delete them, especially on a shared computer.
Who sees it: only our authorised dentists and staff, and others involved in your care (for example a specialist, your doctor, a lab or your health fund) when needed, or where the law requires or allows.
Overseas: your form is stored in Australia and is not emailed overseas. In limited cases Zoho support staff overseas (for example in India, where Zoho is headquartered) may access our account under Zoho's contract and security controls. See our Privacy Policy.
Your rights: you can ask to see or correct your information, or make a complaint, as explained in our Privacy Policy.
Who to contact: clinical questions go to our Clinical Safety Officer (Principal Dentist); privacy and all other questions go to our Privacy Officer. Reach both at customercare@myareedental.com or (08) 9330 7115 (ask for the Clinical Safety Officer or the Privacy Officer).

Filling in for a child under 18 or someone you care for? Please complete the form as their parent, guardian or authorised representative.

1About you
2Contact & emergency
3Health fund & Medicare
4Health check
5Medicines & allergies
6Review & sign

About you

A few details so we can set up your record.

Title (optional)

First name

Middle name (optional)

Family name

Date of birth

For example 07/03/1985

Occupation (optional)

Employer (optional)

How did you hear about us? (optional)

Review & sign

Check your answers, then sign the declaration.

Privacy notice: plain-English summary

We collect your personal, contact, health, dental and health fund details so we can care for you safely. They are handled under the Privacy Act 1988 (Cth) and kept confidential.
With your consent, your dentist may take photos, X-rays, scans and other records needed for diagnosis and treatment, and may request records from previous practitioners.
This form is stored in Australia (Zoho). Only your name, date of birth and contact details go into our contact system; your health answers stay encrypted until added to your record.
You can see or correct your information, opt out of reminders and ask questions at any time. Privacy questions go to our Privacy Officer; clinical questions to our Clinical Safety Officer (Principal Dentist).
Complaints: we aim to acknowledge within 48 hours and resolve within 28 days. You can also contact the OAIC, HaDSCO or Ahpra.

Read the privacy notice (Privacy Policy v1.2 (22 October 2026))

Who we are. Advanced Dental Healthcare Pty Ltd (ABN 48 158 833 713), trading as Myaree Dental & Professional Centre, 84 North Lake Road, Myaree WA 6154. We handle your information under the Privacy Act 1988 (Cth) and the Australian Privacy Principles, and our dentists and staff are bound by professional confidentiality.

What we collect and why. Your personal, contact, emergency contact, Medicare, health fund and government benefit details, and your medical and dental history, so we can provide safe dental care, manage appointments and accounts, and help you claim. With your consent, your dentist may also take clinical photos, X-rays, scans and other records, and may ask your previous practitioners for your records. If you do not give us information we need, we may not be able to treat you safely.

Who sees it. Only the practice team who need it for your care and administration. We share information only with your consent, with others involved in your care (for example a specialist, laboratory or your doctor), with Medicare, your health fund, the CDBS or DVA to process claims, or where the law requires or allows it. We do not sell your information or use your health details for advertising.

Where it is kept. Your dental record is held in our practice management system (Dental4Windows), with supplementary paper record cards kept in locked cabinets. This online form is stored in Zoho Forms in Zoho’s Australian data centres. Only your name, date of birth and contact details are copied into our Zoho CRM (also in Australia); your health answers stay in the encrypted form until we add them to your record. A few services are provided from overseas; section 9 of our Privacy Policy lists them.

How long we keep it. At least 7 years after our last contact with you (for children, until they turn 25 if that is later), then it is securely destroyed. You can ask us to keep your records longer, or to destroy them when that period ends.

Your choices and rights. You can ask to see or correct your information, choose not to receive reminders, and ask questions at any time. Please tell us about changes to your health, medicines or contact details. Requests can be made in person, by phone or online at www.myareedental.com/data-request.

Security cameras. CCTV cameras operate at our premises for the safety of patients, staff and property. Footage is viewed only by authorised staff and is normally overwritten after 30 days.

Questions and complaints. Contact our Privacy Officer about privacy, or our Clinical Safety Officer (Principal Dentist) about clinical matters: (08) 9330 7115, text 0480 012 101, customercare@myareedental.com, or the complaint register at the front desk. We aim to acknowledge complaints within 48 hours and resolve them within 28 days (30 days at most for privacy complaints). If you are not satisfied you can contact the Office of the Australian Information Commissioner (OAIC, www.oaic.gov.au), the WA Health and Disability Services Complaints Office (HaDSCO, www.hadsco.wa.gov.au), or Ahpra and the Dental Board of Australia (www.ahpra.gov.au). Your rights under the Australian Charter of Healthcare Rights are explained at the front desk and at www.myareedental.com/patient-rights.

Full policy. This is a summary of our Privacy Policy (v1.2, 22 October 2026). Read the full policy at www.myareedental.com/privacy, or ask at the front desk for a free printed or large-print copy.

Full policy: Privacy Policy.

Appointment transcription (Heidi)

Our dentists may use Heidi, a secure clinical transcription tool, to transcribe the conversation during your appointment and help draft your clinical notes. Your dentist reviews and edits every note before it goes into your record — Heidi doesn’t make any decisions about your care. You can change your mind or withdraw consent at any time, just tell your dentist or our team, and it won’t affect your care in any way. How we protect your information
Your dentist will also check with you at the start of each appointment.

Yes, I consent to Heidi being used at my appointments No, please don’t use Heidi

Signed by

Patient Parent or guardian (patient under 18)

Type your full name as your signature

Date

Or draw your signature (optional)

Typing your name above is enough. Drawing is optional.

Questions before you start?

Our team is happy to help you with the form. Call, text or request an appointment.

Request an appointment (08) 9330 7115 Text 0480 012 101