Kid’s Consultation Form

    SimplyTeeth Essex, Online Consultation Form for Existing Patients

    Thank you for choosing SimplyTeeth

    As part of our attempt to reduce contact time and decrease the rate of infection, we are asking all patients to prefill Covid Risk assessments and medical history forms. Please fill and sign and submit these secure forms so that they can be loaded onto your record cards before your visit.

    You may experience increased waiting times as we will try and minimise the amount of patients we see, and you may be asked for deposits in advance for the increased price of PPE to be done over the phone prior to your visit.

    Please help us to keep both you and Us safe.

    In these uncertain times we want to make your journey as easy as possible. We offer payment plans of upto 12 months on all treatments over £250 and we are also open evenings till 9pm and Saturdays till 1pm

    Please answer all questions.


    Pre Visit Questions


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    Medical Questionnaire


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    I confirm that all the information I have provided here is correct to the best of my knowledge and that I agree to the terms and conditions of SimplyTeeth Essex.

     

     

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