Medical History Consent Form

Coronation Road Dental Surgery Medical History Consent Form

  • Your Details

  • Your GPs Details

  • Communication Consent Form

  • We process personal data for the purposes of providing optimum dental healthcare, sending important updates to you, providing you with news about treatments and what is happening at the practice and informing you about our services. You can withdraw your consents at any time.

  • Your personal information is never passed to third parties for their own marketing, sales or promotions. We have strict arrangements with companies who process your data on our behalf.

    For further details about how we process your personal information and your data rights please see our Privacy Notice or contact office@coronationroaddentalsurgery.co.uk or call 0117 966 3697 to request a copy of it.

  • I understand these risks and am prepared to accept them and proceed with my appointment.

    Clear Signature
  • I understand that in order to care for my oral health, Coronation Road Dental Surgery may have to share personal data under the terms and conditions of current GDPR.

    Clear Signature