This form is for new dental patients to complete to give us a copy of the information that we need to know to be able to start to offer you dental care.

It contains the following sections:

1. Overview
2. Your contact details, including your permissions for how we are able to contact you;
3. Your understanding of the practice terms and conditions;
4. Your medical history information;
5. Your past dental history, diet and brushing information;
6. Your consent for storing and using images that we take of you;
7. Your COVID-19 screening assessment.

Many thanks for completing this form for us. Your information will be held in the strictest confidence.