REGISTRATION FORM

To get started on your journey and personalised endodontic care, please fill out the registration form below.

New Patient Registration Form

Please use this form to register for treatment at JVC. This form will provide us with important details regarding your contact information and any health details. These details are essential before proceeding with endodontic treatment.

Patient Information
Patient Contact
Private & Confidential Medical Information
Certain medical conditions and medication use require special precautions during dental treatment; so please answer the following as accurately as possible for your safety.
Please list any medical conditions you have or you have had in the past
PLEASE NOTE: IT IS IMPORTANT YOU ADVISE YOUR ENDODONTIST OF ANY CHANGES TO YOUR HEALTH BEFORE EACH VISIT
Emergency Contact
Endodontic Treatment
PLEASE TAKE THE TIME TO READ THE FOLLOWING PARAGRAPH Routine Endodontic (Root Canal) Treatment boasts a notably high success rate, with studies indicating success rates ranging from 90% to 95%. However, cases referred to an Endodontist are typically non-routine, making it challenging to predict treatment outcomes. On occasion, a tooth previously subjected to endodontic treatment may necessitate retreatment, surgical intervention, or, in extreme cases, extraction. Various factors contribute to the potential complications or failure of endodontic treatment, including the initial condition of the tooth, past treatments, bacterial infection types, tooth and oral anatomy, limitations of instruments and procedures, general health, and patient cooperation during the treatment. The cost of treatment typically falls within the range of $1,800.00 to $4,000.00 when the procedure begins. For those seeking a printed estimate, it is advisable to consult with the Endodontist before initiating treatment

Payment Information
PLEASE NOTE: Payment in full is required on the day of your treatment. EFTPOS, credit card (AMEX, Mastercard, Visa) & HICAPS facilities are available. If for any reason, you cannot pay the account in full on the day, please inform us before your appointment. An overdue account will incur additional charges.

Would you like to contact us?

Are you choosing us for your root canal treatment? Please use our registration form to provide us with important details regarding your contact information and health details.

CONTACT US

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