• Patient Medical Questionnaire

    The Information you provide will be treated in the strictest of confidence.
  •  / /
  •  -
  • Past and Current Medical History

    Please answer all questions in this section honestly and truthfully.
  • Declaration and Consent

  • We will process your personal data (including sensitive or ‘special’ personal data in relation to your health) in accordance with our privacy policy.

  • Clear
  • The Slimming Doctor is a trading name for Healthbase Limited, a company registered in England and Wales.
    Registered number: 13418838. Registered office: 71-75 Shelton Street, London, WC2H 9JQ.

  • Should be Empty: