Please Read Fully
Fill in this form completely, as the following information is necessary for us to offer a high standard of care. We have an ethical obligation to keep this information confidential.
I understand that I am about to undertake a Halitosis Consultation with BreezeCare Oral Health Clinics. This consultation will include a Halicheck performed with an Oral Chroma machine as well as analysis of this Lifestyle Quiz. It may also include othertests if deemed necessary such as Saliva testing, Clinical examination, Radiographs, and Periodontal probing.
This Halitosis Consultation DOES NOT INCLUDE additional items such as products that the consultant may recommend to me, scaling or cleaning of my teeth, or any other dentistry. All products and dentistry deemed necessary will be quoted to me first before commencement.