New Patient Policy
We are a Private Family Practice and see patients mainly by recommendations. However, to help all our new patients, we recommend and encourage an informal, no-obligation lunch time visit to the Practice to meet the Dentist and familiarize themselves with the Practice set up.

Recalls
We have an automatic and efficient recall system so our patients do not have to worry about remembering the dates for their check up appointments.

Failed Appointments &
Late Cancellations
We are sympathetic towards failed and cancelled appointments with good reason but we reserve a right to make a charge for all failed appointments and cancellations made without a 24 hour notice.

 
 
Confidential Medical & General Questionnaire

All our new patients are requested to fill in this Questionnaire.
Full Name:
Date of Birth:
 / /
Phone Number:
Address:
Email address:
Occupation:
(If retired previous)
Doctor's Name:
GP Phone No:
Medical Information  
1. Do you suffer from a heart complaint? Or had heart surgery?
(such as Angina/Heart-attack/Murmurs/High Blood Pressure/Pacemaker)		 Yes No

2. Do you suffer from a chest complaint?
(such as Asthma/Bronchitis/TB/Breathlessness)

Yes No
3. Are you a smoker, or have you smoked in the past?  Yes No

4. Do you suffer from any Blood disorders? 
(such as Haemophilia/Sickle cell/Easy bruising/Prolonged Bleeding)

 Yes No
5. Do you suffer from Diabetes?   Yes No
6. If yes, is your Diabetes treated with  Diet Tablets Insulin
7. Do you take any medication?
(such as Warfarin/Steroids/Antidepressants/Blood Pressure Tablets)		 Yes No
If Yes, please list carefully below:

8. Are you allergic to any medications?  
(Especially any antibiotics)         		 Yes No
9. Do you suffer from Fit/Faints/Epileptic attacks? Yes No
10. Have you had Jaundice/Liver disease/Hepatitis? Yes No
11. Have you ever had a General Anaesthetic? Yes No
12. Are you pregnant?  Yes No
13. Have you had any previous bad dental experiences?  Yes No
14. Have you had a bad reaction to a dental anaesthetic?   Yes No
15. Is there anything else you feel your dentist should know? Yes No
If Yes, please mention below:
General Information (Optional)    
1. Are you happy with the state of your teeth and smile?  Yes No
2. Apart from assessing your Basic Dental Fitness would you like to know of other options to improve your Teeth/Smile? Yes No
 
   
   
   

Dental Care for the Whole Family!
Your local friendly family dentist in Northwood, Middlesex in North West London.
We provide all the necessary dental care under one roof, to the highest standard in comfortable surroundings.
Cosmetic Treatments provided with a holistic approach including Dental Implants.

1 Jonathans, 2 Dene Road
Northwood, HA6 2AD
Tel: 01923 824 230
Fax: 01923 842 819
contact@denedental.com
   
 
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