Waterhouse Podiatry & Chiropody, Hebden Bridge
"for all your foot challenges"
Patient Forms
During the Covid 19 Pandemic, in order to reduce contact time with patients, we are asking patient's to complete, the Medical History and Consent Form at home. If you have booked an appointment, you should have been sent an electronic form to complete with your appointment reminder or confirmation. If you are unable to use the electronic form, you can download the form below.
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Then if possible scan or photograph and return by email or text to:
Tel: 07437 015754
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You may also bring your completed form with you at your appointment.
Alternatively, I have paper copies that you can complete at your appointment.
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Medical History & Consent Form during CV19
Please complete if:
You are a new patient, if your medical history/medications have changed, or you have not had an appointment in over a year.