Feedback - Optima Dental Care

Medical History Form

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