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Mouth Mirror

New patient

registration form

Personal details.

Medical details.

Do you have or have you had any of the following?
Please answer the following:

Care Plus agreement.

Our Care Plus scheme is designed to provide you and your family with quality dental care at affordable prices.


As a Care Plus patient you will have the choice of which participating dentist you would like to see.

 

You will be asked to pay an initial consultation fee at the time of booking; this is to secure your first appointment time. We reserve the right to retain this fee in the event of late cancellation or failure to attend.

 

All future treatment costs will be explained to you by the dentist prior to booking your next appointment.


We will ask for 50% of the total treatment cost at the time of booking your next appointment. We reserve the right to retain this fee in the event of late cancellation or failure to attend.

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We accept payment by cash, debit card or credit card. You can also apply to pay for treatment using our 0% interest monthly payment service.


There will be no charge for changing your appointment provided that we are given at least 24 hours notice.

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