treatments about blog contact smiles dental health plan go to dentalsurgerygroup.co.uk

Join the NHS Waiting List at Harlow Dental Surgery.

Please fill out the form below to be added to our NHS Waiting List. Alternatively, if you wish to be seen sooner and are happy to be seen privately, please fill out our Private Patient Registration.

private patient registration

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

•

a dental surgery group practice since 2014

NHS Waiting List Form

Please fill in one enquire form per member of family.

Patient Details

Are You An Existing Dental Surgery Group Patient?^*

If 'Yes', Which Dental Surgery Group Practice Are You Currently Registered With?

Title^*

First Name^*

Last Name^*

Date of Birth^*

Address^*

Postcode^*

Occupation^*

Phone Number^*

Email Address^*

Your Experience with the Dentist

How Do You Usually Feel About Visiting the Dentist?

Are There Any Treatments You Feel Especially Anxious About?^*

How Did You Hear About Us?

Please Tell Us How You Heard About Us^*

Referral Source

Your Dental Needs

How Urgent is Your Dental Problem?^*

More Details^*

Why Do You Need to See the Dentist? Select All That Apply^*

Important Information

NHS waiting list appointments are only available Monday–Friday, 10am–3pm. Please note that we are unable to accommodate new NHS patients onto our waiting list if your residential area is located more than 15 miles away from our practice. We cannot provide a definite time frame for acceptance as an NHS patient.

I consent to giving my details for the purpose of being added to the NHS Waiting List and being contacted in response to this form*.

I would like to be seen sooner privately, and understand that there will be a £100 consultation fee. The dentist will explain any further treatment costs in writing before treatment begins.

I would like to hear about special offers and updates from Dental Surgery Group.

Thank you! We have received your enquiry. A member of our team will be in touch with you as soon as possible.

Something went wrong when submitting your enquiry. Please try again or email us at info@ashwelldental.com

Practice Address

Harlow Dental Surgery
Chadwick House
Hamstel Road
Harlow
CM20 1EP

We provide NHS and private dental services to the population of West Essex.

Call The Practice: 01279 425 640 / 01462 743117
Email The Practice: info@harlowdental.com

Opening Hours

Monday: 8.30 - 12.30 / 13.30 - 17.00
Tuesday: 8.30 - 12.30 / 13.30 - 17.00
Wednesday: 8.30 - 12.30 / 13.30 - 17.00
Thursday: 8.30 - 12.30 / 13.30 - 17.00
Friday: 8.30 - 12.30 / 13.30 - 16.30
Saturday / Sunday / Bank Holidays: Closed

By clicking “Accept”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. View our Privacy Policy for more information.

Accept Deny