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Online Medical History

Your Medical and Dental Health History Form

Please complete this form with as much detail as possible. If you opt to leave some information out, please discuss this with your dentist at the time of your consultation. Referral patients who are registered elsewhere with another dentist do not need to complete the Dental Health History section.

Personal Details
Contact Details

We will not pass your email address on to third parties.

Your Medical Health History

All information is confidential. Please complete as detailed as possible. Please select Yes or No to the following questions:

Women only

Your General Medical Practitioner
Your Dental Health History Form
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Contact Details

020 7226 0849
66 Upper Street, London N1 0NY


IGDP Ltd is registered as a limited company in England.
Company Number: 05893145
CQC Regt No: 1-296264131

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