PLEASE ANSWER THE FOLLOWING QUESTIONS PRIOR TO VISITING OUR PRACTICE
MEDICAL HISTORY FORM
It is important for us to establish each patient’s COVID-19 status and medical history before confirming an appointment.
If it is essential that the patient is accompanied by a parent, carer or comforter, then that person should also be screened at this point.
The symptoms listed in the latest NHS case definition14 of COVID-19 are:
- new continuous cough,
- new fever/high temperature,
- new loss of, or change in, sense of smell or taste (anosmia).
Please fill in the form below before visiting our practice.
“I am absolutely delighted with the end results of my dental treatment, it has allowed me to smile with confidence now that my teeth look great. The service from everyone at Ballyclare Dental practice was exceptional, throughout the process they ensured I was seen quickly and at a time that suited me.“