About Us

Title: ---MrMrsMsOther

Medical Doctor

How did you hear about us: ---GoogleWebsiteWalk byYellow PagesAdvertReferred by your GPPersonal Referral

Do you suffer from any of the following?

 High blood pressure Heart ailment Rheumatic fever Asthma, chest or breathing problems Tuberculosis Stomach or bowel problems (eg ulcer) Kidney disease Diabetes Depression (needing medication) Excessive bleeding or blood disorder Epilepsy Hepatitis AIDS/HIV Osteoporosis or bone tumour

Do you smoke: ---NoYes

Previous illnesses:

Would you like to discuss these questions in private with the dentist? ---NoYes

Do you have an artificial hip, heart valve or other prosthetic implant? ---NoYes

Have you ever had problems with dental treatment? ---NoYes

Are you presently under medical care? ---NoYes

Are you taking any drugs, medicines or tablets? ---NoYes

Female patients, are you pregnant? ---NoYes

Do you have allergies?