Brooklands Dental Clinic in Broughton, Milton Keynes offer a complete range of dental treatments. Providing cosmetic, specialist, restorative and well being treatments. Brooklands Dental Clinic in Milton Keynes is a state of the art modern dentistry clinic. Dentist Referral Service - Refer your patients for specialist dental care Referring Dentist Login Contact Brooklands Dental Clinic in Broughton, Milton Keynes UK
 
Cosmetic & General
Complete Smile Makeovers
Tooth Whitening
Porcelain Veneers
Crowns
Bridges
Cosmetic Fillings
Gum Line Correction
ClearStep
Wedding Smile Makeovers
Specialist Dentistry
Sedation Dentistry
Periodontics
Dental Implants
Prosthetics
Surgical Extractions
Restorative Dentistry
Preventive Dentistry
Dental Hygiene Visits Endodontics
Aesthetic & Well-being
Anti-Wrinkle Treatments
Dermal Fillers
Weight Management

Life Skills Coaching

When coming in for your initial treatment, it is necessary to complete a Patient Medical History Form to help us highlight any special needs you may have.

Download the Patient Medical History Form in PDF format.
» Click here to download

General Details:
Title:
Full Name:
Date of Birth:
House/Flat Number:
Street:
Town / County:
Postcode:
Tel No. Home:
Mobile
Email:
Occupation:
Work No:
Referred by (if another patient please state name):
When did you last visit:
- The Dentist
- The Hygienist
To help us provide the best possible treatment, dependant upon your needs, we would appreciate if you could indicate below which treatments interest you?
Treatment of Pain Only
Regular Hygiene for maintenanceof healthy gums
Cosmetic Treatment
Whitening of your teeth
Implants (replacement of teeth)
White fillings
Facial Aesthetics
Other
How would you prefer to be contacted by us?
Recall examination:
Confirmation of appointment:
Medical History Update:
Do you have a history of, or ever suffered from the following? (Please tick only those that apply)
Heart Arthritis Heart Surgery Pacemaker
Rheumatic Fever Kidney Liver Disease Chest Problem
Hayfever Asthma Diabetes Anaemia
Hepatitis HIV Epilepsy High/Low BP
Giddiness Thyroid Allergies Other
For other and/or allergies, please give details
Do you smoke?

Yes No

If so how many per day?
Do you drink Alcohol? Yes No
If so how many units per day?
Have you ever had a bad reaction to a general or local anaesthetic? Yes No

Are you under the care of a doctor at present?


If yes, please give details

Yes No

Are you currently taking medication?


If yes, please give details

Yes No

If you are pregnant, please give expected birth date:
If you are allergic to any drugs, please give name of drug/s
Details of person to contact in an emergency:
Name:
Phone:
Medical Doctors Name:
Phone (If known):
Security:
Confirmation code: *
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Ask Brooklands Dental Clinic - Located in Broughton, Milton Keynes
Our team of Dentists & Specialists are happy to answer any questions you may have about any of our dental treatments.
Dentist in Milton Keynes, UK - Brooklands Dental Clinic provide a wide range of cosmetic, restorative and specialist dental treatment.
We invite you to take a tour of our exquiste state-of-the-art dental & specialist clinic online.
 
 
             
             
Home Our Treatments About Us For Patients For Dentists Referring Dentist Login Contact Us
 


Cosmetic Dentistry
Complete Smile Makeovers
Tooth Whitening
Porcelain Veneers
Crowns & Bridges
Cosmetic Fillings
Gum Line Correction
Wedding Smile Makeovers

Specialist Dentistry
Sedation Dentistry
Endodontics

Periodontics
Dental Implants
Prosthetics
Surgical Extractions

Restorative Dentistry
Preventive Dentistry
Dental Hygiene Visits

Aesthetic Treatments
Anti-Wrinkle Treatments
Dermal Fillers


Our Philosophy
Tour Our Practice
Why Choose Us?
Our Awards

Meet Our Dentists
Dr Juliane Scandian

Meet Our Specialists
Dr Etienne Deysel
Dr Mark Jackson
Dr Michèle Kebert
Dr Hennie van Jaarsveld

Meet Our Hygienists
Juleanne Eaton
Sarah Taylor

Meet Our Nurses
Hayley Bateman
Charli Cunningham

Meet Our Support Staff
Jacqui de Jager
Rita Conway

Nicole Newcombe



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Brooklands Price List
Commonly Asked Questions
Self Referral Form
Medical History Form
Special Offers
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Brooklands Dental Clinic Ltd is a Registered in England and Wales, Registration No 06111975,
Registered address: Brooklands Dental Clinic, Brooklands Farm, Broughton, Milton Keynes MK16 0HU