Would you like to request a consultation with one of our dentists?

Please complete the appointment form below to request a consultation at Hanover House Dental Clinic. Once you have submitted your preferred times and dates, a member of staff will be in touch to arrange your appointment with you.

We look forward to caring from you.

General Details

Full Name: Phone Number: Mobile Number: Email: Service Required: Please Select ----------------------------- Comprehensive Examination Oral Hygiene Program Pain-less Local Anaesthetic IV Sedation Fillings & Restorations Smile lifts Tooth Whitening Crowns Bridges Dental Implants Dentures Specialist Periodontal Treatment Root Canal Treatment Minor Oral Surgery Day / Date Please Select ------------ Monday Tuesday Wednesday Thursday Friday only) Time 8:30am 9:00am 10:00am 11:00am 12:00pm 1:00pm 2:00pm 3:00pm 4:00pm 5:00pm If Other, please let us know the service you require: Would you like to receive a FREE COSMETIC CONSULTATION (worth £35) during the month of November? Questions / Comments: The following section must be completed : Confirmation code: * Please type in the black letters exactly as they appear in the image to the right into the box above it.