A&S Dental Surgeons Ltd
A&S Dental Surgeons Ltd 



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]
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]
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]
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