Wales COVID Reporting Form

My Health Board is:
Please enter the name of your practice as known locally
for example MyDentist Swansea South or Mrs Smith's Dental Practice Ltd
Enter your practice postcode
Updated Practice Address

Street Address

Street Address Line 2

CityCounty

Postcode
Your Name

First NameLast Name
GDC Number
Email
We recommend using a practice email - such as reception@dentalsurgery.com

Please provide the following information on NHS patients

These data are collected to help Welsh Government and Health Board's understand the dental services need during the COVID 19 period.
Please enter the number of telephone calls received from NHS patients.
Please do not enter a telephone number, nor the cumulative number of calls - just those received in the reporting period.
Please enter how many times a dentist in your practice has provided remote advice to an NHS patient.
On how many occasions has the dental practice issued a prescription to an NHS patient?
How many referrals have you made to urgent/emergency centres for NHS patients?
How many occasions were NHS patients assessed or treated in your practice?

Please provide the following information on AGPs for NHS patients.

These data are collected to help Welsh Government and Health Board's understand the dental services need for PPE.
Are you providing aerosol generating procedures for NHS patients?
What types of procedure are you offering NHS patients?

Other
How many AGP did you undertake within the reporting period for NHS patients?

Are you or any of your staff unwell with COVID symptoms, or have tested postive?
Please tell us more about staff who are unwell, self isolating or tested positive. Please enter numbers of staff and positions, for example Dental Nurse, Dentist, Practice Manager
Any comments or concerns to raise with Health Board?
All urgent matters and contractual matters should be raised with the HB directly.
Sign here to complete the COVID reporting
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