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Patient Online Medical History Form

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Dear Patients: Please Complete This Medical History Form

IMPORTANT: Unfortunately, we do not provide NHS treatment for new patients.

  • Please only fill-in the form below once you have spoken to Sophie from our reception team on 020 3808 5114
  • Your information will be collected securely as per GDPR guidance and is GDPR compliant
  • You may request a copy in-clinic as we will not send an email copy to ensure the protection of your personal data
  • Once your form is submitted you will receive a reference number
  • Please take note of this as it may be required in-clinic

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  • 91a The Broadway, Wimbledon, London, SW19 1QE
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Opening Times

  • Mon. 9am - 1pm, 2 - 5:30pm
  • Tue 9am - 1pm, 2 - 6pm
  • Wed 9am - 1pm, 2 - 8pm
  • Thu. 9am - 1pm, 2 - 5:30pm
  • Fri. 9am - 1pm, 2 - 4pm
  • Sat. 9am - 1pm (By Appointment Only. 2 Per Month)
  • Sun. Closed

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Last modified: 17/11/2021

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