Emergency number 01672 512418

Medical History

It is important for your dentist to have your medical history up to date and understand your health needs before any examination or treatment is carried out.

You have two options:

  1. You can either fill in the Medical History Online below OR
  2. Download the Medical History form, print it out, fill it in and then hand it in at reception.

1. MANUAL FORM FILL-IN

Click here to download the MEDICAL HISTORY FORM.

2. ONLINE FORM FILL-IN

Please fill in as many details as you can.  Fields which have this symbol * need to be filled in.

 Please note that when you click the SUBMIT Button at the bottom, all your details will be sent via email to Savernake Dental Practice in Marlborough and are completely confidential.

If you are a totally new patient, please click here to fill in the FULL NEW PATIENT FORM.

Medical History Form


Medical History

Units of alcohol

1pint = 3units,  Wine 175ml = 2 units,   Alcopop 1.4 units,   single spirit = 1 unit,   Bottle wine = 10 units .

* Required

If your form has been successful you will get a Thank You message on the screen, otherwise scroll back up and make sure you have entered all the required fields.

Denplan
Denplan
Invisalign
Dentsply
Inman Aligner
Regulated by CQC