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Due to additional precautions resulting from the COVID-19 pandemic, please submit this completed form at least 2 days before your appointment.
Please list all the medicines or drugs (prescribed, over the counter or self medication) you take on a regular basis (including contraceptive pills, recreational drugs). If possible, please include dosages and frequency.
I consent to my clinical images and data being shared within the practice for the purposes of clinical care and with dental or medical colleagues outside the practice such as anaesthetists, dental or medical colleagues, dental laboratories and other third parties directly involved with or advising on my clinical care.
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28 February 2024
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