Consent and Enrolment for Oral Health Services
Oneroa Dental Surgery is pleased to offer free dental treatment again in 2020 to adolescents from School Year 9 until their 18th Birthday.

Treatment will be carried out by Bronwyn Weaver, Dental Therapist under the Combined Dental Agreement contract held by Dr Nick Stretton.
Email address *
Treatment that is provided at no charge:
- Annual examination
- Radiographs (x-rays)
- Preventive fluoride application where appropriate
- Fissure sealants
- Scale and polish (cleaning)
- Oral hygiene instruction (teaching brushing techniques)
- Single surface fillings (white, not mercury amalgam)
Treatment that requires Prior Approval from Ministry of Health:
- Extensive fillings
- Splints
- Periodontal disease treatments
- Dentures
- Crowns
Treatment that is NOT provided under the contract, and will therefore charged privately only after you are given a quote and treatment plan:
- Sports mouth guards
- Tooth whitening
- Orthodontic related treatment
- Orthodontic hygiene appointments
- Orthodontic extractions
- Sedation procedures
- ACC treatment
Patient's first name(s): *
Patient's last name(s): *
Date of Birth: *
Sex: *
School attending in 2020: (or note if not attending) *
School Year in 2020: (eg: 9) *
Daytime phone number: *
Mobile phone number: *
Full residential address: *
*
Required
Full name of legal guardian or patient granting consent *
Any further questions or comments?
A copy of your responses will be emailed to the address you provided.
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