New Patient Enrolment

Confidential Patient Questionnaire

By submitting this form, you confirm that the information provided is true and correct to the best of your knowledge.

  • Personal Information

  • Personal Information

  • Important

    Although rare, accidental injury to staff can occur during handling of used instruments. If this happens during the course of your treatment, our practice requires both patient and staff member to undertake a blood test.
    In order to provide the best and safest dental treatment, your dentist needs to know of any medical problems which may affect your treatment. Please tick if you have or have previously had any of the following: