Clinic ClosedRe-Open Monday at 9:00 am

New Patients

The Registration Procedure

1

Complete the form below

2

Book a new patient appointment

3

Discuss your dental needs

4

Smile with confidence

New Patient Registration Form

Personal Details

Title

First Name

Surname

DOB

CONTACT DETAILS

Address

Address2

City

Postcode

Phone Number

EMail

Dental Enquiry

Select Topic

Description

If you have any documents you would like to send us please attach below.
Documents to send:
1. Medications (Prescription)
2. Radiographs (X-Rays)
3. Previous Treatment Plan
4. Any relevant documents

File Upload

Consent

I consent to my personal data being collected and stored as per the Privacy Policy.

Consent2

I agree to being registered as a private patient at Ilford Dental Care

Ilford Dental Care

Work Time

Mon-Fri: 9AM - 6PM Sat: 9AM - 1PM Sun: CLOSED

Contact Us

ILFORD DENTAL CARE LTD trading as Ilford Dental Care with its registered address at 180 Thorold Road, IG1 4HA, Ilford, United Kingdom is authorised and regulated by the Financial Conduct Authority and entered on the Financial Services Register, reference number 935663.