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Kois Assessment



Thank you for booking a new patient assessment at Queensway. You will have been asked to complete some documentation prior to your visit and may be thinking ‘why do they need all of this information just to check my teeth?’

We understand that the forms that we use are quite comprehensive, but it is critically important that your dentist collects detailed information about your overall health, previous dental treatment and experiences to ensure that your initial exam is thorough and complete.

The information provides your dentist with an informed starting point when gathering information about you. Systematic diseases and some medications can make dental problems more likely and successes (and failures) of past treatment are important clues about your unique situation.

If you have any questions or require any assistance with the form please contact reception on 01642 554667 ext 245.

If you have not already booked a free new patient consulation, please complete an online form or call us on 01642 554 667.

If you have already booked your consultation and have been asked to complete the assessment, you can do it online.





Please click the following link to complete the Medical and dental history form

Please follow the above link to the medical and dental history form, it will take around 10 minutes to complete. Once submitted it will be sent securely to us in preparation for your initial assessment.

*Please only complete this form if you have an appointment booked at Queensway Dental Clinic*