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.

Then if possible scan or photograph and return by email or text to:

waterhousepodiatry@gmail.com

Tel: 07437 015754

You may also bring your completed form with you  at your appointment.  

Alternatively, I have paper copies that you can complete at your appointment.

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.