e-Reception
Dear Patient,
Due to Covid-19 restrictions we are having to do things a little differently.
To reduce contacts in the practice we can now carry out much of the paperwork online.
Below you will find:
Information on charges and exemptions for NHS patients
NHS Patient Declaration Form
Medical History Questionnaire
Please read and as requested by reception please print, complete and sign.
You can then either photograph and email us the forms to asdentalsurgeons@icloud.com or
WhatsApp to 07375857543
NHS Dental Charges Exemptions Information
No need to send us a copy of these!
NHS Dental Exemption information.pdf
Adobe Acrobat document [258.8 KB]
No need to send us a copy of these!
NHS Dental Exemption information.pdf
Adobe Acrobat document [258.8 KB]
NHS Patient Declaration Form
We must have a signed copy of this form for you to obtain NHS Dental Care
Patient Declaration Form-1.pdf
Adobe Acrobat document [1.9 MB]
We must have a signed copy of this form for you to obtain NHS Dental Care
Patient Declaration Form-1.pdf
Adobe Acrobat document [1.9 MB]
Medical History Form
We require a signed copy of this form. You may send a photo of your repeat medication list you use at the pharmacy for the section on medication.
Medical History Form .pdf
Adobe Acrobat document [145.8 KB]
We require a signed copy of this form. You may send a photo of your repeat medication list you use at the pharmacy for the section on medication.
Medical History Form .pdf
Adobe Acrobat document [145.8 KB]
Print 