Confidential Medical History

  • List and state doses for any prescribed medicines, tablets, ointments, injections or inhalers (inc. contraceptives and HRT) you are taking:
  • Confidential Oral Health Survey

  • Please tell us about your oral health. Tick any of the statements below that apply to you.
  • Please note that payment is required at the time of treatment. All cost in relation to collection of overdue accounts will be added to your account. Appointments not kept, failed, or cancelled without 48 hours’ notice may incur a charge.