NHS

Please complete the form below to be added to the waiting list. A member of staff will contact you to arrange an appointment. This could take up to six weeks.

Requirement or need

NHS Registration ( checkup )
Private Hygiene 30 mins
Crown
Pain
Root Canal
Extraction
Filling
Broken tooth no pain
Whitening
Cosmetic treatment

Patient Type

Fee Paying NHS
Exempt NHS
Private

Title

Mr
Mrs
Miss
Ms
Master
Mx

First Name*

Last Name*

Phone Number*

Address First Line*

Post Code*

Date Of Birth*

Date Of Birth

E-mail*

AF Dental Dover

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+44-01304804660

1-2 Biggin Street, Dover CT16 1BD, UK