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Medical History Form Online


It is important for your dentist to have your medical history up to date and understand your health needs before any examination or atreatment 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 Corn Market Dental Practice in Wimborne and are completely confidential.

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

February 2021
We continue to remain OPEN during the new lockdown and wish to inform you that
travel for dental care is allowed under the new lockdown rules.

We are continuing to do everything we can to keep you and our teams safe and protected.