Medical History - O'Hagan & Murray Dental Practice

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About Us
Treatments
Emergency Dentist
Prices
- Our Pricing
- Payment Options
Call Us
- Newry – 028 3026 2057
- Rathfriland – 028 4063 8733
Contact Us
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About Us
Treatments
Emergency Dentist
Prices
- Our Pricing
- Payment Options
Call Us
- Newry – 028 3026 2057
- Rathfriland – 028 4063 8733
Contact Us

Forms

Medical History, O’Hagan and Murray, Newry

Medical history questionnaire

This questionnaire is designed with your safety in mind. Your answer will be reviewed prior to your appointment. Thanks for your consideration and understanding.

Step 1/4: Personal details

Leave this field blank

Phone number

First name

Last name

Email address

Current dentists details

Current GP details

Medical history

Are you currently pregnant?

Are you currently receiving treatment from a doctor, hospital or clinic?

Are you currently taking any prescribed medicines (eg tablets, ointments or inhalers, including contraceptives and hormone replacement therapy)?

Are you carrying a medical warning card?

Do you suffer from allergies to any medicines (eg penicilin), substances (eg latex/rubber) or foods?

Do you suffer from hay fever or eczema?

Do you suffer from bronchitis, asthma or other chest conditions?

Do you suffer from fainting attacks, giddiness, blackouts or epilepsy?

Do you suffer from heart problems, angina, blood pressure problems, or strokes?

Are you a diabetic, or have a family history of diabetes?

Do you suffer from arthritis?

Do you suffer from bruising or persistent bleeding following injury, tooth extraction or surgery?

Do you suffer from any infectious diseases (including HIV and hepatitis)?

Have you ever had rheumatic fever or chorea?

Have you ever had liver disease (eg jaundice, hepatitis) or kidney disease?

Have you ever had blood refused by the Blood Transfusion Service?

Have you ever had a bad reaction to general or local anesthetic?

Have you ever had a joint replacement or other implant?

Have you ever had a treatment that required you to be in hospital?

Have you ever had heart surgery?

Have you ever had brain surgery?

Did you recieve a growth hormone treatment before the mid 1980's?

Do you have any close relatives (parent, sibling, child, grandparent or granchild) with creutzfeldt jakob disease?

Lifestyle

Do you regularly drink more than 21 units of alcohol per week?

Do you smoke any tobacco products now (or did you in the past)?

Do you chew tobacco, pan, use gutkha or supari now (or did you in the past)?

Do you suffer from depression, anxiety, Autism, learning difficulties or ADHD?

Location - Newry

Address:
10 Trevor Hill
Newry
BT34 1DN
Phone:
(028) 3026 2057

Location - Rathfriland

Address:
40 John St
Rathfriland
BT34 5QJ
Phone:
(028) 4063 8733

Opening Hours

Monday: 8:45am - 5:30pm
Tuesday: 8:45am - 5:30pm
Wednesday: 8:45am - 5:30pm
Thursday: 8:45am - 5:30pm
Friday: 8:45am - 5:30pm
Saturday: Closed
Sunday: Closed

Email

info@ohaganandmurray.co.uk

Legal & Info

Patient Privacy Notice
Complaints Policy

© 2026 O'Hagan & Murray Dental Practice. © 2025 O'Hagan & Murray Dental Practice.
The Real Good Dental Company Limited trading as O'Hagan & Murray is an Appointed Representative of Chrysalis Finance Limited, which is authorised and regulated by the Financial Conduct Authority. The Real Good Dental Company Limited is a credit broker, not a lender. The provider of a payment scheme which is not offered through or by Chrysalis Finance Limited may not be so authorised and regulated.

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