Corona

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Home
About Us
- Our Team
- Fee Guide
New Patients
Treatments
Contact Us
- Sundries
- Location
Blog

Birchfield Dental Practice

We are so happy to be providing face to face care to our patients.

We can now accept bookings for all emergency and routine dental appointments, we are still working under a number of restrictions and taking all precautions possible to ensure your safety at all times.

Before Visiting the practice

Please take a few moments to watch this short video prior to visiting the practice.

Medical Update

Please complete the information below at least 24 hours before your appointment.

* Indicates required field

Name *

First

Last

Email *

Has there been any changes to your medical situation? *

Yes No

If yes, please provide details *

Are you taking any new medications? *

Yes No

If yes, please provide details *

Coronavirus Screening

Declaration *

Please tick this box to confirm you have watched the video above

Have you or anyone in your household experienced any symptoms of coronavirus in the last 14 days *

Yes No

a new continuous cough, shortness of breath, a fever above 37.8 degrees centigrade, changes to your sense of taste/smell.

Have you or anyone in your household tested positive for coronavirus in the last 14 days? *

Yes No

Have you or anyone in your household been in contact with anyone known or suspected of having coronavirus? *

Yes No

Have you or anyone in your household travelled outside of the local area in the past 14 days? *

Yes No

Have you had a COVID Vaccine? *

Yes No

If yes, when? *

Submit

Birchfield Dental Practice, 23 Spencer Road, New Milton, Hampshire, BH25 6BZ
t. 01425 615080 e. contactus@birchfieldpractice.co.uk
TO ACCESS OUR OUT OF HOURS SERVICE PLEASE CALL 01425 615080

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Site last updated 11/09/2020

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