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  • New Patient Questionnaire

  • Thankyou for visiting The Wells Clinic today. So that we may provide the best care possible, please take a few minutes to complete our New Patient Questionnaire.

    Please note that all information provided is strictly confidential and is held in accordance with the Data Protection Act.

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  • Past medical problems

    Please indicate date of diagnosis and any other relevant information to all which apply.

  • Lifestyle

    Please answer these questions honestly in order that we can help you in the best way possible.

  • Disclaimer

    Sending information via the internet cannot guarantee 100% security. Should you have any concerns about sending your personal details using the web, please attend your appointment 15-20minutes prior to your appointment in order to complete a form by hand.

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