Dental Implants and Cosmetic Dentistry in the UK

GENERAL ENQUIRY FORM

Please fill in the form below, completing all fields before submitting,
or text your request to 07501 684251.

	Patient's Name
	Address
	Postcode
	Telephone Number
	Mobile Number
	E-mail Address

	How would you like us to contact you?	Telephone Email Letter
	Reason for your enquiry ?
	If your enquiry is about implants, have you already had an implant consultation?	Yes No
	If so, where have you had this?
	Information Required Please give as much information as possible regarding the treatment you think you may require, or the previous implant treatment you have received, in the box below.

	PLEASE NOTE If you have recently had an Implant Consultation with another Clinic we are happy to offer a 'like for like" comparison. Simply send us a copy of the treatment plan either by post or email and we will return a comparison of cost within two working days. Patients can avoid having to travel to our clinic for an implant consultation if they can send us a recent Panoral X-Ray (Also known as an OPG or a Panoramic X-Ray). Your usual dentist will be able to provide one of these, if not then another local dentist will. Alternatively, we are now also offering Consultations with a CT scan in London , Glasgow, Manchester, Leamington Spa, Bristol, Guildford, Brentwood & Tunbridge Wells If you prefer not to have to travel for the initial consultation, then please mention this in the 'Information Required' text box. We will then send you details of where to attend, nearest to your home address.
	Where did you hear about us?

Dentalcare Plus, Tel: 01579 389623