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:
- You can either fill in the Medical History Online below OR
- Download the Medical History form, print it out, fill it in and then hand it in at reception.
1. MANUAL FORM FILL-IN
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 Michael Shipway & Associates Dental Practice in Cheltenham and are completely confidential.
If you are a totally new patient, please click here to fill in the FULL NEW PATIENT FORM.