Privacy Statement

1. This form asks you to provide certain personal data (for example, some details of your health history). We will use this information to help provide you with safe and effective health services, to contact you when necessary about your treatment, appointments and visits, and to monitor how our services are accessed and used.

2. We respect your privacy and the privacy of your data. The information entered into this form is securely encrypted and cannot be seen by anyone else. Your personal data is never passed to third parties for their own marketing, sales or promotion. We have strict arrangements with companies who process your data on our behalf

We want to provide safe and effective care, so it's important that we know of any conditions that affect your general health. If you'd like to discuss any issues arising from this questionnaire, please ask to speak with your dentist.

Please press the 'SUBMIT' button to complete the form

Thank You!