The aim of this form is to assist your dentist in providing you with safe and optimal care.
The aim of this section is to assist your dentist in assessing whether you are in a vulnerable group where we may need to take additional precautions.
Please excuse the fact that some questions may appear as duplications from the previous section.
Have you or anyone in your household been suffering with a:
Additional guidance regarding your attendance:
Before arriving at the practice, we ask you to: