Medical History Form

We ask you for information about your general health to help us treat you safely. Please fill out your contact details below, answer the health questions and then accept the terms in the last section. We will use this form at later visits to discuss any change in your general health. All information will be kept strictly confidential by the people caring for you.

Your Visit Today

Gum Health

Gum health has an impact on general health, you may need to see our hygiene team or periodontist

Do you suffer from, or are you concerned about, any of the following:

Smile Capture

How did you hear about us?