Register as a new Private patient

at Marlborough Orthodontics

Please complete the form for each patient wishing to join us as an affordable private patient. The exam charge for this offer is £30 for general dental examination which includes dental radiographs. The clinician will give you quotation for your treatment after the initial examination.

Register as a new Private patient

Titil*
Full name*
Date of Birth*
Date Format: DD slash MM slash YYYY
Home Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Phone*
Email
Last visit to dentist*
Date Format: DD slash MM slash YYYY
Do you have any pain or swelling?
Do you have any other dental needs?

There is high volume of patients wishing to join us. We appreciate our patient’s patience and want to inform below information to meet the demand. Based on you answer above, we will offer appointment with our Dental therapist who can do exam, filling and gum treatment. If you see Dental therapist and some area needs to be reviewed by dentist: you will be asked to see our dentist. If you have complex issue then patient will be offered examination with our dentist.

We will process your form at earliest and offer you with our dental therapist or dentist depending on your dental needs.

If you need an urgent care, please ring 111.