Appointments

• These days a lot can be done to prevent the need for dental treatment, such as fillings. Would you like to know more about this preventive approach to your own or your children's dental care?

  YesNo

• Are you satisfied with your teeth and their appearance?

  YesNo

• Are you self-conscious about your teeth when you smile?

  YesNo

• Do you wish your teeth were whiter?

  YesNo

• Do you wish your teeth were shaped differently?

  YesNo

• Do you have any irregularly positioned teeth, which you dislike?

  YesNo

• Do you have any discoloured teeth, which embarrass you?

  YesNo

• Do your front teeth have fillings, which do not match the colour of your teeth?

  YesNo

• Do you wish the fillings in your back teeth were tooth coloured instead of black?

  YesNo

• Do your gums appear red and swollen and bleed when you brush them ?

  YesNo

• Do you suffer from bad breath - halitosis?

  YesNo

• If you could alter your smile what would you most like to change ?

• On a scale of 1 - 10 how happy are you with your smile?12345678910

• Your full name

• Address

• Telephone number

• Best time to contact

• Email address

• Are you currently a patient with us?

  YesNo

• Which practitioner would you like to see?Gareth SmallLidia FerrittoSarah LocheadLoraine Dunlop (Therapist)

• When would you like your appointment?

• What time would you like your appointment? (Please state 3 preffered times)

• N.B. We may not be able to give you the exact date or time requested but will endeavor to meet your requirements as closely as possible.

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