Covid-19 self-assessment form 


We ask you to complete the Covid-19 self-assessment form below on the evening or morning before your dental appointment (but no more than 24 hours beforehand).

Your responses will of course be treated in confidence.

If you do answer yes to any of the questions we would ask that you do not attend the practice.  Please phone or email us and we will re-schedule your appointment.

Having filled in the assessment form, should you be taken ill with COVID-19 symptoms on the day of your appointment, please do not attend. Please let us know of your change in condition by phoning the practice on 01445 712240 or emailing 

Covid-19 Health Declaration

Thanks for submitting!

*Covid-19 symptoms are clearly explained on our 'Covid-19' page for your consideration - if in doubt, call us before coming or visit the NHS website