Private Dentist Waiting List Form

Please complete the information below in awareness of the Data Protection declaration statement. Until we contact you, you cannot make a dentist appointment. Whilst waiting for us to complete your private dentist registration, you can visit our private dental hygienist using the direct-access method.

This field is mandatory

This field is mandatory

This field is mandatory

This field is mandatory

This field is mandatory

This field is mandatory

I am over 18 years of age and a UK citizen. I hereby agree that my personal data entered in the New Patient 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, if dentist availability and diary space permitting, creating a dental patient contact medical record. 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.*

This field is mandatory

* Indicates required fields
There was an error submitting your message. Please try again.
Thank you! We will get back to you as soon as possible.

Copyright © 2024 Wedgwood House Dental Practice (WHDP) |  Site last updated:  27 November 2024

This site is protected by reCAPTCHA Enterprise and the Google Privacy Policy and Terms of Service apply. 
This is in addition to WHDP's Privacy Notice.                                                                                                                                                                                           Login

We need your consent to load the translations

We use a third-party service to translate the website content that may collect data about your activity. Please review the details in the privacy policy and accept the service to view the translations.