MyMy
Dental
Passport
Dental Passport
Dental staff:
please read my
passport before
you do anything.
1. If I have to go to the dentist
this book needs to go with me.
2. It gives staff important
information about me.
3. It needs to be with me and a
copy put in my notes.
Things you must know about me
Date of birth
Address
Postcode
Phone number
Who should be contacted
if I am upset or unwell
(next of kin)
Their phone number
Things I need help with
How best to communicate with
me
What worries me about going to
the dentist
My doctor is : Dr
My GP surgery address is:
My GP surgery phone number is:
These people from the learning
disability team work with me:
Things that help me when I am
upset:
Things that help me when I go to
the dentist
Things that don’t help me when I go
to the dentist:
Put anything else you want the dentist
to know here.
The medication and tablets I take:
Date completed:
Do you have any allergies?
Do you have any problems when you
eat and drink?
Do you have your drinks thickened?
Do you have any problems with your
heart?
Do you have any problems with your
breathing?
Dou you have epilepsy?
Yes
No
What type of seizure do you
have?
What help do you need when
you have a seizure?
When was your last
seizure?
Has a doctor said that you bleed
more easily than other people?
Tell us about any problems you
have with your physical health
(please put date written.)
If you do not have a dentist you can find one by
visiting www.nhs.uk or calling 111.
The Learning Disability team can also help you.
South Team: 01865 903100
City Team: 01865 904555
North Team: 01865 903500.
Oxfordshire Community Dental Service
Oxford Health NHS Foundation Trust
Astral House
Granville Way
Bicester
OX26 4JT
Email: Oral.Health@oxfordhealth.nhs.uk
Oral Health Improvement team: 01865 904040
Website: www.oxfordhealth.nhs.uk
Health and social care professionals may order this
and other resources from hpu.oxfordhealth.nhs.uk