• Medical History


    It is important to know details about your medical history as these could affect the success of your Orthodontic treatment and how we can provide this treatment safely for you. The information you provide is confidential and will be handled in accordance with our strict privacy policy.

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  • DD slash MM slash YYYY
  • Names and ages of siblings
  • Have you ever had any of the following, if so, please tick and give any relevant details:
  • MM slash DD slash YYYY