It is always very helpful for us to know your dental history and what you would like to achieve by attending LCIAD. Every patient is different and has personal views about their dental health.  We therefore request that you complete this Dental Questionnaire before your first consultation so that we can learn what is important to you before you attend. Please do take the time to do it completely, every detail is important. You can start the form and return to it later to complete by using the Save button.

If you are a new patient to LCIAD, please ensure that we receive your completed Dental Questionnaire form at least 72 hours before your consultation together with your Medical History Questionnaire (MHQ) so that we may prepare properly for your first visit.

Your data will be securely stored and protected.

(Note: For patients who wish to see Dr Milvia Di Gioia for facial aesthetics only and do not have dental care at LCIAD, please complete the Medical and Facial Aesthetics Questionnaire (MFAQ) here:


Follwing feedback from patients, we have recently made some changes to our Medical and Dental History questionnaire (MDQ) by separating them into two forms – the old Medical and Dental Questionnaire is now divided into two forms:

The Medical History Questionnaire (MHQ) which needs to be completed and updated at every visit. Your existing data is maintained so you do not need to complete the whole form again, but a new link will be sent before your next appointment which you should keep for future updates.

A separate Dental Questionnaire (DQ) which only needs to be completed once by New Patients.

This is to avoid the once-only dental questionnaire from cluttering up the Medical History Questionnaire (MHQ) which needs to be updated each visit.

Thank you for your understanding during this transition.