Private Payment Plan Enquiry

Wedgwood House dental practice intends to offer a private payment plan from April 2026. This enquiry form is to understand the level of interest from our patients (NHS or Private) whether they would like to join a monthly payment scheme to spread the cost of regular services such as dental checkups and hygienist (Airflow) sessions. Other benefits include a worldwide emergency dental cover and (related followup) treatment insurance cover.

A null response is not required. If you want to keep seeing us as an NHS or 'Pay As You Go' private patient, we will not force you to change to the payment plan.

Should you be determined suitable to join the private playment plan, your private clinician (dentist, dental therapist, dental hygienist) will recommend which scheme option is applicable to you.

Please note that submitted forms will help us plan for the scheme's introduction from April 2026. We will contact you from April 2026, or otherwise please ask at the reception desk for more information (from April).

Private Payment Plan Enquiry

Name:*

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Date of Birth (dd/mm/yyyy):*

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Address:*

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E-mail address:*

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Mobile number:*

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I am an existing private patient (dentist, therapist or hygienist) of WHDP, and would like a payment plan to spread-out my private appointment fees each month.

I am an existing NHS patient, and a monthly payment plan would allow me to have private hygiene (Airflow) appointments.

I am an existing NHS patient, and a monthly payment plan would make me convert to private dental checkups and hygiene (Airflow) appointments.

I am over 18 years of age and a UK citizen. I hereby agree that my personal data entered in the Private Payment Plan Enquiry Web Contact Form will be stored electronically by Wedgwood House Dental Practice, and will be processed and used for the purpose of establishing contact and assess overall customer demand for a payment scheme at Wedgwood House Dental Practice (WHDP). I am aware that I can revoke my consent at any time, though deletion of dental records is prevented by the UK Data Protection Act 2018. The dental practice reserves the right to exclude requests from ex. (inactive) patients.*

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Thank You. We will take your response into consideration.

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