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0330 043 3771

Dental

Improving your smile is one of the best investments you can make. Boost your self-esteem and enhance your interactions in both your business and personal life by getting the best dental care service. Strong and healthy teeth equal a healthy smile. Please fill out the form below so that our clinicians can determine if the treatment will be suitable for you to take.

About the Condition and Treatment

To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

0%

Have you undergone a tooth decay, enamel demineralization, or tooth wear examination by your dentist in the last 6 months?

Yes

No

Can you relate to any of the following?
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.

Yes

No

If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option

Presently Pregnant

Presently Breastfeeding

Planning on getting pregnant

Neither Pregnant nor Breastfeeding

What is your biological gender?
Please select your option

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Do you experience sensitivity to fluoride or any of the other components in toothpaste?

Yes

No

Have you used any other fluoride-containing products, such as mouthwash, for the same purpose lately?

Yes

No

Do you have a history of using Colgate® Duraphat®?

Yes

No

Are you on any medications that cause you to have dry mouth?
If you do, please explain which drug is causing these side effects and how serious they are.

Are there any wounds, injuries or open cuts in your mouth?

Yes

No

Do any of the following symptoms apply to you:
Toothache
Sensitivity of the teeth, particularly when eating or drinking something hot, cold, or sweet
Spots on your teeth that are grey, brown, or black

Yes

No

Do you visit your dentist every six months for a checkup?

Yes

No

Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

Yes

No

We are Sorry!

Based on the answers you have provided you are not eligible.

If you believe this to be an error or you would like to discuss this further, please contact us.

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About Us

Bolt Healthcare Ltd. is a UK Registered Online Pharmacy. As a registered UK pharmacy, we offer you a wide choice of medicines online, some with and some without prescription. We are dedicated to providing exceptional services and top-quality medications.

Bolt Pharmacy, Suite 204A, Business First, Davyfield Rd, Blackburn, Lancashire, BB1 2QY
0330 043 3771
For Sales & Orders:
hello@boltpharmacy.co.uk

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How to check GPhC Registration

Please visit the relevant website here for information about how to check the registration status of the pharmacy and the superintendent pharmacist.

GPhC Registration Number:

GPhC Registered Owner:

Bolt Healthcare Ltd

Superintendent Pharmacist:

Saim Dalvi (2080851)

GPhC Pharmacy Details:

Bolt Pharmacy, Suite 204A, Business First, Davyfield Rd, Blackburn, Lancashire, BB1 2QY

GPhC Prescriptions Supplier:

hello@boltpharmacy.co.uk

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