New Patient Registration Form (Online) New Patient Registration Form Online – Click Here × PATIENT REGISTRATION FORM FORMULATION DE INSCRIPTION Surname : Name : Date of Birth : Nationality : Address : Contact Number : Email : Are you taking any current medication? : Do you have heart or circulation condition? : Do you have any allergies to medication? : Do you suffer bleeding problems? Are you taking anticoagulants? : Do you have any other diseases? : Are you pregnant? : YESNO We inform you that the personal data provided will be included in a File of responsibility of Adnan Kaiserimam. These may be communicated and /or transferred to third parties, such as dental professionals and dental prosthetics, in those cases where necessary. Please check the box dependingon whether or not you want this to happen: YES / NO You can exercise your right of access, rectification, opposition and cancellation by sending an email to reception@tl-dc.com If you want more information regarding the Data transfer please visit our website: https://thelondondentalclinic.com Missed appointments may result in a 20 euro penalty. How did you hear about us? : RadioGazetteGoogleRecommendation New Patient Registration Form (Offline) New Patient Registration Form Offline – Click Here If you have booked an appointment with us and this is your first visit, you may find it more convenient to download our registration form and fill in at your convenience. Then simply hand the completed form to the receptionist when you attend the clinic. CLICK HERE TO DOWNLOAD: New Patient Registration Form Crown and Bridge Consent Form – Click Here Crown and Bridge Consent Form Implant Treatment Consent Form – Click Here Implant Treatment Consent Form Photography Consent Form – Click Here Photography Consent Form Aftercare Sheets Implants Aftercare Sheet To download the form please click the link: Implants After Care Sheet Crowns Aftercare Sheet To download the Crowns Aftercare Sheet please click on the link: Crowns Aftercare Sheet Extraction Aftercare Sheet To download the Extraction Aftercare Sheet, please click the link: Extraction Aftercare Sheet Fillings Aftercare Sheet To download the Fillings Aftercare sheet, please click the link: Fillings Aftercare Sheet Boutique Whitening Aftercare Sheet To download the Boutique Whitening Aftercare Sheet, please click the link: Boutique Whitening Aftercare Sheet Whitening Aftercare Sheet To download the Whitening Aftercare Sheet, please click the link: Whitening Aftercare Sheet Root Canal Aftercare Sheet To download the Root Canal Aftercare Sheet, please click the link: Root Canal Aftercare Sheet