Call for an appointment
01223 461 381

Medical History

Medical history

Confidential Medical History Form

So we can treat you safely, we need certain information about you and your general health. Please answer all the questions on this form as accurately as you can. When we see you, we may ask you for further details about any questions you have answered 'yes' to.

We'll also follow up these issues at regular intervals so we're always updated about any changes in your general health. Of course, we'll keep all your information strictly confidential.  

Please fill out the form online and press submit when you have finished.         

Alternatively, to print this form, click on this link and print out the PDF version of the form. Then fill it in, and either bring it when you come for your next appointment, or send it to our postal address: Granta Dental, Newnham Road, Cambridge, CB3 9EY.

Identity Information

Contact information

Medical information