If you are a new patient requesting an appointment, we will need you to complete a medical history questionnaire providing us with information that will help us to treat your individual needs. This can be done at our practice before your appointment, online or you can print out our medical history questionnaire to complete at your leisure before your appointment.
Please fill in the online form below or if you prefer, please download Word version of the form and email the form to firstname.lastname@example.org
Thank you for giving us the opportunity to care for your oral health and smile. In order to provide high standard of care and treatment, please review and complete the following questionaire. It will be handled confidentially.