Urgent Dental Treatment

Triaging Questionnaire For Urgent Dental Treatment

1. Your Details

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2. Urgent Dental Problem

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Photo(s): If appropriate, please feel free to take a maximum of 2 photos to send to us following the tips below

  1. You will need to use a phone camera and the flash needs to be turned on.
  2. Please follow the example below to take a total of 2 photos.
  3. You will need a spoon (see example below) to hold your lips and cheeks out of the way near the affected tooth. (Only zoom the camera a small amount and hold the phone nice and close to the teeth, ensure the images are in focus and clear.)
  4. Once you have competed all the photos, please attach the photo(s) to an email and send to your dentist with your full name and date of birth in subject line.
  5. The photo may look like this
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Swelling (Only fill in this section if there is swelling. Otherwise go to 4. DENTAL PAIN) Have you taken photos of the swelling? Please email to your dentist.

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3. Dental Pain

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4. Health Status

COVID-19 Risk Assessment

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5. General Medical Health

Medical Health Assessment

Please tick YES or NO beside each medical condition AND write down the drugs taken next to the condition.

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Contact Us

Personalised Dental Care For You and Your Family         

Get in touch with Rapid Response Dental for all your dental needs

Get In Touch With Rapid Response Dental and Hygienist For All Your Dental Needs Get in touch with us to book an appointment for a check-up or any dental issues.

Ground floor access - wheelchair friendly, disabled off-street parking. Free street parking

  • plain icon 3277 Broadway Avenue, Palmerston North
  • plain icon 315A Queen Street, Dannevirke