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Due to Covid-19 and a change in regulations we now have to screen patients before an appointment can be booked.
Please complete BOTH of the forms below in as much detail as possible (if anything is left blank you will be asked to do it again).
Although we may already have a medical history for you we need all patients to submit a complete and updated version of this.

Confidential Medical History Questionnaire

This provides the dentist with important information required for your Dental Treatment and Oral Health Care.
Please advise us if you require any help with completing this form.

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You will need to complete and submit each form individually


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Covid screening questionnaire

Please advise us if you require any help with completing this form.
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You will need to complete and submit each form individually.

Positive responses to any of the above questions would likely indicate the need for a deeper discussion with the dentist before proceeding with elective dental treatment.



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