Confidential Medical & Dental History Form

Please complete this form prior to your first dental appointment at Northern Dental Specialties

It is important to know details about your medical history as these could affect the success of oral health care (dental treatment). The information you provide is confidential and will be handled in accordance with our privacy policy which is shown on the second page of this form.

Please fill in the online form below or if you prefer, please download Word version of the form and email the form to

Download PDF Confidential Medical & Dental History Form