Pre-Appointment (Covid Status) Form

Due to the COVID-19 pandemic, the safety of our team and our valued patients is our main priority. In addition to our increased infection control procedures, we have therefore also had to introduce some new ways of working - one of which is asking all of our patients to complete the below Pre-Appointment (Covid Status) Form before you visit us for your appointment.

Thank you in advance for your co-operation on this, and for taking the time to help us keep everyone protected. We look forward to seeing you soon!

Patient Details

Please ensure you select either 'Yes' or 'No' to answer all of the questions below:

COVID-19 Status

COVID-19 Testing

Additional Health Questions

Problems with your Braces
If yes, what problems are you having?

Sign Off

By clicking 'send' you are consenting to us replying, and storing your details. (see our privacy policy).

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