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 20 minutes to complete and has been developed over many years of experience and has been recently updated to incorporate additional questions necessitated by COVID-19. 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 form at least 72 hours before your consultation so that we may prepare properly for your first visit.

If you are already a patient at LCIAD, we must 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. In future you will not need to re-enter all of the data, just edit what has changed and resubmit. 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: