Medical History Form

Medical History Form

To obtain best and safest treatment, your dentist needs to know if any problems which may affect your treatment:

1. I am the patient completing this form / I am the parent or guardian of the named child under the age of 16years completing this form.

2. I accept that the information I have given is true to the best of my knowledge and I have not withheld any information concerning my / my child's health.

Recalls & Reminders by Letter: These are messages sent to remind you of upcoming appointments, if you are due your regular dental check-up or if you have missed an appointment.

Practice Updates by Letter: These are messages the practice will need to send occasionally regarding any updates such as cancellation of appointments, if the practice is closed or other such messages.

Special Offers & Promotions by Letter: These are messages the practice will send on the odd occasion regarding special offers, promotions or other such messages.

Make a Payment Online
Online Dentist