New Patient Registration and Medical History Form

As a digital dental practice, we kindly request you to fill out the form provided below. Once you submit the form, one of our dental team members will get in touch with you for a follow-up. However, at the moment, we are only accepting NHS patients as and when our capacity permits. If your enquiry is regarding NHS registration, we will contact you as soon as we have the availability of spaces. Thank you for your understanding and cooperation.

Step 1 of 3

Please tick the relevant box regarding your enquiry:(Required)

MM slash DD slash YYYY
DD slash MM slash YYYY
Are you a Dental Plan Member?
× Message Us