We take your health very seriously. It is vital for all patients attending LCIAD to complete our secure and confidential Medical and Dental Questionnaire (MDQ) before their first appointment. It is designed to give us all of the information we require to provide you with the best care possible. This form will take around 15-20 minutes to complete and has been developed over many years of experience. 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.
If you are a new patient to LCIAD, please ensure that we receive your completed form at least 48 hours before your consultation so that we may prepare properly for your first visit.
If you are already a patient at LCIAD, we will also update this form each time you attend the practice to ensure that we always have the up-to-date status of your current medical and dental health. Your data will be securely stored and this form will be editable in future without needing to be completed in full again.
(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: