COVID-19 Screening & Consent

  • Personal details

  • DD slash MM slash YYYY
  • COVID-19 Patient Screen Form

  • Positive responses to any of these may involve a deeper discussion with your dentist before proceeding with elective dental treatment or scheduling your appointment appropriately. Patients with conditions such as heart disease, high blood pressure, diabetes, obesity, or who are older than 60 or from a BAME group may have a higher risk at this time.
  • Signature COVID-19
  • This field is for validation purposes and should be left unchanged.