Thank you for your interest in booking a consultation.  Please complete the short form below and you will be contacted shortly.

First Name *
Surname *
Email *
Telephone *
Mobile *
Enquiry
	Please write a brief description of the dental treatment that you are interested in and any other useful information
Date of	Thursday 18th February 2010Friday 19th February 2010
Consultation	Tuesday 23rd February 2010 Wednesday 24th February 2010
	Tuesday 2nd March 2010 Wednesday 3rd March 2010
	Tuesday 9th March 2010* Wednesday 10th March 2010*
	Thursday 11th March 2010Friday 12th March 2010
	Saturday 13th March 2010Tuesday 16th March 2010
	* Implant day with Dr Attila Halasz
	Please select one or more dates for a consultation and we will contact you with the times available.
X-ray	yes I have an x-rayno I need to have an x-ray taken
Call	morningafternooneveningweekendanytime
	Please indicate the best time to call
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If you wish to request a preliminary quote (subject to alteration after a personal consultation), please complete the form below, providing as much information as possible and a quote will be prepared for you.

First Name
Surname *
Date of Birth
Email *
Telephone *
Mobile *
	Have you recently been examined by a dentist?
Assessment	yes I haveno I have not
Treatment Plan		If available, please send a copy of the treatment plan
	Do you have a current panoramic x-ray?
	yes I haveno I have not
X-ray		If available, please send a copy (max size 2MB)
Treatment	tooth extractionimplantsbone graftingcrowns/bridgesveneers
Details of Enquiry *		Please write a brief description of the dental treatment that you are interested in and any other useful information
spam filter *		Please enter letters in the box