Records Update Questionnaire

Please Note: If you do not wish to complete the questionnaire online please contact the surgery and we will arrange a paper copy to be sent to you.

1Patient Details

(1st 3 Chars)
(1st 3 Chars)

2General Medical Details

Metres & Cm or Feet & In
Kilogrammes or Stones & Lb
Systolic Over Diastolic

3Contact Details

(your-email@address.com)

Although sending information across the Internet means that privacy of data cannot be absolutely guaranteed, our online forms offer high levels of security. The forms use HTTPS and TLS (using a 2048 bit certificate) to encrypt data sent to and from your computer when using the site and our server environment is PCI DSS certified - the highest standard of security associated with e-commerce and online finance solutions.

Form submissions are stored on the server for 28 days and are encrypted and secured with a private key known only by the GP Practice.

Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

Thornton Heath Dental Practice Linden Lodge Dental Practice
© Neighbourhood Direct Ltd 2017
97 Parchmore Road, Thornton Heath, Surrey, CR7 8LY
  • Telephone 020 8251 4200
Practice Website supplied by Oldroyd Publishing Group
Thornton Heath Dental Practice Linden Lodge Dental Practice
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