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Thorpe Road Staines-upon-Thames Middlesex TW18 3EQ
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Below you will find a list of forms to complete prior to your dental appointment.
Please ensure you complete the COVID19 risk assessment before ANY dental appointment.
If you are attending for your routine check-up please complete your “existing patient medical history” here as well.
If you are a new patient please complete the consent forms for “Communication”, “Photographs” and “Referrals””, as well as your “New Patient Medical History” and “Smile Analysis”.

Existing Patient Medical History

New Patient Medical History

Smile Analysis

Consent For Clinical Photography

Consent For Referrals

Communication Consent Form

Consent for Direct Access with a Hygienist

COVID-19 additional Medical History update