Call us 01482 841146
8/9 Castle Green
Cottingham, East Yorkshire  HU16 5JU
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New Patients 

Our dental practice is able to accept new patients on the following basis:

Online registration form
Your first name:
Your surname:
Your date of birth:
Your telephone:
Your email:
Your address:
 
 
Your town:
Your county:
Your postcode:
   
People to be registered
 Name D.O.B. [dd/mm/yyyy] Private/NHS
 
 
 
 
 
  I consent to my personal data being collected and stored as per the Privacy Policy.
  I consent to my personal data being collected and stored for the purpose of marketing communications.
Although we take every precaution to ensure patient confidentiality we cannot guarantee that the information you provide on this form can be transmitted securely via the Internet. If you are concerned about this please telephone us.