• COVID-19 Patient Screening Form

     

    Shiraz, 389 Warwick Road, Solihull
    West Midlands, B91 1BJ
    Tel: 0121 709 1660

  •  /  /
    Pick a Date
  •  -
  •  -
  •  /  /
    Pick a Date
  •  
  • These will be checked again on the day of your appointment. 

  •  /  /
    Pick a Date
  •  
  • Positive responses to any of these would likely indicate a deeper discussion with the dentist before proceeding with elective dental treatment.

  • Should be Empty: