New Patient Registration

Now Accepting New NHS Patients * to be seen by our Dental Therapists

Click here to register as a New Patient Today

Now Accepting New NHS Patients * to be seen by our Dental Therapists

Click here to register as a New Patient Today

New Patient Registration

Blank Form (#3)

First Name

Middle Name (if applicable)

Last Name

D.O.B (Date of Birth)

Home Address

Home Phone Number

Mobile Phone Number

Email Address

Preferred Method of Contact

Mobile

Interested in

NHS

Private

Comments box (If seeking private treatment, please provide information in relation to what kind of private treatment you are enquiring about)

NHS Patient Enquiry Pre-Screening

Our NHS books are currently open to be seen by a Dental Therapist. Our Dental Therapists are highly trained GDC registered Dental Professionals who carry out a wide range of treatments under the NHS banding system.

In the event you have any swelling or affecting eye sight and/or breathing, please contact NHS 111 immediately.

To help us determine whether you qualify for an NHS appointment, please answer the following correctly:

When was your last dental checkup? (Approximate Year)

Do you have any pain/swelling or what may look like an abscess?

Have you been told you need new dentures, root canal treatment, crown work or extractions on adult teeth?

If you have answered yes to any of the above questions, we are unable to register you for a check up with our Dental Therapists. In the event a NHS slot with a dentist opens up, you will be contacted by a member of the Dentahub team for the earliest possible appointment.

Note, if following an examination with our Dental Therapist you require treatment outside of their scope of practice, you will be advised of your options by a member of the team following your checkup.

Please list any medication you are taking below. If none, please write N/A in the comments box below.

New Patient Registration

NHS Patient Enquiry Pre-Screening

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