Medical history questionnaire

If this is your first visit to Bow Lane Dental we require you to complete a medical history questionnaire prior to any treatments.

Personal information

Your dental health

Your medical health

Are you taking any of the following...

In the past have you had...

Questions for Women only

And finally...

Data privacy

We store your medical history securely to help us provide accurate and safe treatments to you. For information on the data we store and how we use this data please visit our privacy policy.

During treatment we may take photographs of your mouth and teeth. The photographs might be used for clinical purposes relating to my treatment and kept with my confidential dental records and for teaching purposes. I understand that their use will be in accordance with the 1998 Data Protection Act and that the photographs will be made anonymous when used for any purpose not directly related to my dental care.

Please click to opt in to our newsletter. Your privacy is important to us and we pledge to send you no more than one email a month and will never pass your data to third parties.

We're a dental and orthodontist practice providing high quality, private dentistry services in the City of London

Get in touch
020 7236 3600
Bow Lane Dental Group, 2a Bow Lane, London, EC4M 9EE
Opening hours
Monday  07:45 - 17:30
Tuesday  07:45 - 19:15
Wednesday  08:30 - 19:15
Thursday  07:45 - 17:30
Friday  07:45 - 17:00
Join us for news

We send a few newsletters each year with news, details of new treatments and exclusive offers. If you’d like to receive this information please add your email address below. We take your privacy seriously and promise no-one else will be given your details!