We take the health of our patients very seriously. Consequently, we need to ask you for very detailed information on your general health before you attend LCIAD Face.

This form will take around 20 minutes to complete. (You can start the form and return to it later to complete.)

This form should be completed by patients attending to see Dr Milvia Di Gioia for facial aesthetics consultation and procedures only. I you are attending for dental / TMJ dysfunction or sleep-related conditions, please complete our LCIAD Medical History Questionnaire and Dental Questionnaire on our dental website

Please complete the questionnaire as thoroughly as possible to ensure that we are able to give you the best possible care. This form will only need to be completed once and will be stored securely for future editing as you attend the practice in the future.

We thank you for your time and patience and look forward to meeting you at your consultation.


LCIAD DENTAL LCIAD ACADEMY LCIAD FACE