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Please complete the form below in as much detail as possible (if anything is left blank the form will be rejected and you will be asked to do it again).

Although we may already have a medical history for you we need all patients to submit a complete and updated version of this.

Confidential Medical History Questionnaire

This provides the dentist with important information required for your Dental Treatment and Oral Health Care.

Please advise us if you require any help with completing this form.

Which is your preferred contact method for appointment reminders?

Are you receiving any medical treatment at the present time?*

Have you been a patient in hospital during the past two years?*

Do you take any medicine tablets, capsules or drugs at the moment?*

Do you have a disability or long term health condition that you feel would require us to make reasonable adjustments? If yes, please tell us what facilities / adjustments / equipment you may require?

Do you have any allergies, including any unusual effects from any tablets, drugs, injections or anaesthetic?*

Have you ever had any of the following? If so, please tick as appropriate.

Have you had any prosthetic surgery? (E.g. Heart Valve or Hip Replacement)*

Is there any other relevant medical information you feel your dentist should know?

Woman: Are you pregnant?

Do you smoke/vape?*

Do you drink alcohol?

How did you find us?

I agree that Chase Side Dental Practice may use my mobile & email address to contact me regarding appointments and related information about my treatment and to send copies of referral letters. I understand that I can opt out of this by contacting the practice. I give permission for my dentist to send digital communications (x-rays and clinical photographs of my teeth) when referring me to a specialist*

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We love our patients

Comments from G.B

“First class treatment and care through out. Many thanks”

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Comments from H.I

“I am completely satisfied with the treatment I receive. My dental maintenance is very challenging for you due to my ongoing medical situation. I appreciate…”

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Comments from B.E

“My family is relatively new to the practice, under the care of Deborah and Luciana, for which we would like to take this opportunity, to…”

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Comments from N.W

“Saw Lucy the hygienist today she is a very affable lady and immediately puts me at my ease. She is very informative and explains each…”

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Comments from P.T

“"Dear Doctor Olga, and Dear Doctor Stern, I would like to express my sincere gratitude for the excellent dental treatment affected by your selves. You…”

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Comments from D.F

“"Just wanted to thank you for all your kindness, for been so professional and the same time so friendly. I never feel anxiety when I…”

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Comments from P.P

“"I was fortunate to discover Chase Side Dental when I developed a terrible abscess a year ago and was referred to Sharon Stern who is…”

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Collected from our comments box in reception area.

“Reliable friendly and excellent treatment. I have Olga and Sharon. I like honest approach to every situation.”

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Comments from J.B

“I was receiving chemotherapy when an abscess brought that to a close. I came to Olga in great pain and she treated me with respect…”

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SB on Dr Olga Argyros

“Just to say that I am really pleased with your practice. Everything is always efficient, sparkling clean and all the staff and friendly and cheerful.”

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10.01.2019 on Dr Olga Argyros

“"I just wanted to say thank you for your diagnosis of the lump on my thyroid, during your examination. I have had an operation and…”

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Mrs RS on Dr Stern

“"I thought Dr Stern was amazing and am grateful that I had the treatment there."”

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Mrs NR on Dr Sharon Stern

“"I was simply amazed at the wonderful painless experience I had this week with Sharon. Wow! This was undoubtedly the best ever dental experience. No…”

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Mrs PL on Dr Olga Argyros & Lucy (Hygienist)

“I am a new patient and so impressed with the expert treatment I have received from Olga and her team. The atmosphere is helpfully calm…”

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Mr BA on Dr Olga Argyros

“At this examination on the 16th November Dr Olga discovered a lump under my chin. Dr Olga wrote a letter of referral to a consultant…”

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Mrs K.T. on Dr Olga Argyros

“Very detailed explanation, very patient. Excellent service!”

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Mr A.A. on Dr Sharon Stern

“I recently was treated by Dr Stern. The procedure sounded like it could be painful and tricky, but my experience was the opposite! From the…”

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Mrs M.P. on Dr Olga Argyros

“I cannot praise Olga and her team enough. If there is anyone that goes the extra mile with her patients it is definitely her. Nothing…”

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Mrs S.P. on Dr Sharon Stern

“Of lately I visited Dr. Sharon Stern for my root canal treatment. Till the visit I was sceptical whether the procedure will go smooth or…”

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Mrs A.W. on Dr Olga Argyros

“I have nothing but praise for this practice, Olga is great and very gentle but thourough in her care. The reception staff are always helpful…”

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Comments from Mr J.F

“Throughout Chase Side Dental Practice, you unfailingly meet the same calmness from Reception to Olga in surgery and Lucy the hygienist. That calmness underpins the…”

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Comments from Mrs S.G

“The current Dental Practice is very special, state of the Art. The Staff are very kind, attentive and patient; from reception to practitioners! I feel…”

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Comments from Mrs J.W

“I am very happy with the treatment I get from your practice. All staff are pleasant and efficient, your new premises are always clean and…”

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Comments from Mr D.K

“I had a very good session Sharon explaining what she was doing throughout the treatment, and I would like to thank you all for your…”

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View ALL Testimonials

General Dentistry

We treat you like a member of our family.

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Cosmetic Dentistry

Our range of cosmetic treatments will give you the smile...

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Specialist Dentistry

State of the art dentistry.

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Dental Implants

Restore your smile with Dental Implants.

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Endodontics

We offer a full range of advanced root canal treatments.

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Facial Aesthetics

Enhancing your appearance – naturally.

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Dr Olga Argyros

Practice Principal

Dr Sharon Stern

Specialist Endodontist

Dr Deborah Lipman

Associate Dentist

Miss Luciana Visintin

Dental Hygienist

Mrs Karen Brown

Dental Nurse

Mrs Runak Nasir

Dental Nurse

Ms Narvada Hurdoyal

Dental Nurse/Receptionist

Jehona Xhameta

Trainee Dental Nurse

Mrs Lisa Statham

Receptionist

Ms Phoebe Licheri

Receptionist

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