“I was extremely insecure about my teeth and I would never smile in photos and would always complain to her friends how much I disliked my natural teeth as they were extremely small and mis-shapen. I discussed how I felt with Mohan and I decided to have Teeth Whitening and Emax crowns. Now I have had the smile makeover my insecurity over my teeth has completely gone and I never expected such an amazing result. He has done such amazing work that I now have a beautiful smile and teeth which has changed my confidence and been the highlight of my year. Thank you!“
Patients may complete the online medical history form by simply clicking on the PDF file above and once uploaded onto your device, please complete all fields and electronically sign by writing your full name in the signature box.
Sending the form using a mobile smart device
click on the ‘share icon’
select email
on your ‘subject’ header please enter the branch you wish to attend e.g: Kingston, Tadworth, Isleworth, Epsom
send the email with attachment to
you will receive an automatic ‘noreply’ email acknowledging safe receipt of your message
Sending the form using a PC
download the PDF form by clicking on the icon above
complete all fields on the form and save the file to your PC
from your email attach the saved file
on the email ‘subject’ header, please enter the branch you wish to attend e.g: Kingston, Tadworth, Isleworth, Epsom
send the email with attachment to
you will receive an automatic ‘noreply’ email acknowledging safe receipt of your message