We understand these are unusual times. In the interests of maintaining the best possible chance of minimising the risks to our patients, their families, the wider public and ourselves we request that during National COVID-19 alert status LEVEL 3 or higher all patients wishing to be seen complete the self-assessment form below and submit it at least three working days prior to their dental appointment. We fully understand that some patients may be more risk averse than others or have a personal need to remain isolated or shielded. Where necessary we will continue to offer remote Advice, Analgesic (pain killer) advice or Antibiotic prescriptions where appropriate.