It is 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.  Please complete this Dental Questionnaire before your first consultation so that we can learn what is important to you before you attend. Please take 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: