Please enable JavaScript in your browser to complete this form.1Type of Consultation2Information3PaymentBook Your Consultation ! *Composite Bonding Consultation (Virtual and Face-to-face) - £ 35.00Invisalign Consultation with our dentist (deductible from treatment if goes ahead with the Invisalign Package) - £ 50.00Advanced Cosmetic Dentistry e.g. Porcelain crowns and bridges - £ 50.00Whitening consultation with our dentist (deductible from treatment if you proceed) - £ 50.00New patient examination & x-rays (with dental therapist or dentist) - £ 70.00Skin and body consultation (required for all aesthetic treatments - with Lauren or Jasmin) - £ 0.00Book a call with treatment co-ordinator for further information. - £ 0.00Please note all bookings are subject to our terms and conditions - please ensure you read this fully before checking the box!NextType of Treatment your looking for? *Laser Hair RemovalCavitation Inch LossRadiofrequency Skin TighteningAnti Wrinkle InjectionsFat Dissolve InjectionsB12 InjectionBiotin InjectionLash lift and tintChemical PeelMassageSkin MesotheraphyHair Rejuvenation InjectionsSkin BoosterLiquid LipoCan select multiple treatments.Type of Treatment your looking for? *Composite BondingTeeth straightening (Invisalign)Advanced Cosmetic Dentistry (e.g. porcelain bridges/crowns)WhiteningGeneral dentistrySkin and body aesthetic treatment (e.g. Laser Hair Removal)Name *FirstLastPhone *Email *Address *Address Line 1CityState / Province / RegionPostal CodeDate of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Note : Cosmetic dentistry is only available for patients over 18.LayoutHow did you hear about us? *Instagram OrganicGoogle OrganicFacebook OrganicWord of MouthFacebook AdsInstagram AdsGoogle AdsSeen the Practice SignPub advertisingOthers (Please Specify)Referred by? *Other *Do you need special assistance? *YesNoIf 'Yes', please specify *BackNextPlease select your preferred time for our call. *Please Select your preferred time for our call.Morning (8:00- 12:00)Afternoon (12:00-17:00)Evening (17:00-19:30)Please note we aim to contact you on next working day. Please refer to our 'Contact Us' page for our Opening Hours. Our evening telephone appointments are only available on Tuesdays.Total£ 0.00Payment Information. *Terms and Conditions *I consent and agree to the Terms and ConditionsBackBook Now!
