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Streatfield Dental Surgery

206 Streatfield Road, Middlesex, Harrow HA3 9BU

 0208 204 9485

Open on Saturdays and evening by appointment

 

Patient Registration


 

Private Patient NHS Patient

Patient Name

Phone Number

Email

Post Code

NHS Number (if registering as NHS Patient)

Message

Preferred Date

Preferred Time

Please tick how you would like us to contact you regarding your dental care via:    Email    SMS    Letter

Please tick for us to enable to send promotional material relevant to your dental care via:    Email    SMS    Letter

  I understand the practice will hold all my personal data securely in compliance with GDPR May 2018 and it will only be accessible to authorised members of staff:

 

Please note you are not fully registered with Streatfield Dental Surgery until you have had a dental health check with us which must be within one month of submitting this form.