Online Registration
You may register online for our practice but you are required to come in for a pre-registration check up before we can formally accept you as a patient. Please fill in the details requested below and we will contact you to arrange an appointment. We look forward to seeing you soon.
If you need an earlier appointment you can ring us on:-
During Surgery Hours: 029 20 555035 / 20564167
Out of hours 029 20 555035 (
20564167 will not respond
)
Consultations are by appointment only.
In an emergency, please telephone the surgery and you will be seen as soon as possible.
Outside normal hours an answerphone will give you the information you require for assistance.
Please supply the following details:-
Gender:
Male
Female
Title:
Full Name:
Date Of Birth:
E-mail:
Telephone Number:
Address:
Enter extra comments you may have in the space provided below:
©2004-2006 Wilton Dental. All rights reserved.
Terms of Use
.
Website Design
by
Designer Websites