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.

New patient smile package

$150 New Patient Smile Package

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

New patient professional clean

$190 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

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.


Any surgical or invasive procedure carries risks. Before proceeding with a surgical or invasive procedure, you should seek a second opinion from an appropriately qualified health practitioner.

Robina Town Medical CentreBupa Members FirstHCF Dentisure Denticare QIP Accredited