Your Details

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Marketing Authorisation

Details of person to contact in an emergency

Medical History

1. Are you receiving any medical treatment at the present time?
2. Are you routinely taking any medicine tablets, dietary supplements, capsules or drugs?
3. Have you experienced any unusual effects/allergies from any tablets, injections or anaesthetic?
4. Have you ever had any of the following? If so, please tick as appropriate:
5. Have you had any prosthetic surgery? (I.e. Heart Valve or Hip/Knee Replacement)
6. Did your surgeon advise you that you require Antibiotic Cover for dental treatment?
7. Do you smoke or vape?

Our Practice Policies

Full payment is required on the day of your appointment. A fee may be charged for missed appointments or appointments cancelled with less than 2 business days’. notice. Unpaid accounts may attract interest and debt collection fees. I agree for my de-identified photos being used for educational or marketing purposes.
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Our aim is to provide you with a beautiful smile, a comfortable and efficient bite and excellent oral health

At Dental Artistry we’re dedicated to providing you with exceptional dental treatment in a practice that adheres to the most stringent safety and quality measures.

Our dentists, and patient support team are committed to treating you with kindness and respect.

Tell us about your dental goals and we’ll do our utmost to help you achieve them.

09 524 4541
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