Appointment

Make an appointment

If you would like to make an appointment in our practice, please complete the request form and we will be in touch to confirm as soon as possible. We look forward to seeing you!

PERSONAL DETAILS
Title		Name
Phone		Mobile
Email		You are a
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Coupon/Promo Code:

PREFERRED DATE & TIME
TO REQUEST AN APPOINTMENT, PLEASE COMPLETE YOUR PREFERRED DATES AND TIMES.
CHOICE 1
Date		Time
CHOICE 2
Date		Time
CHOICE 3
Date		Time
What is your preferred time to be contacted?

QUESTIONS
To ask us a question about your dental health, use the box below and we will contact you with the best possible advice available from our surgery.
Questions related to your appointment

MEDICAL HISTORY QUESTIONNAIRE
If you are a new patient requesting an appointment, we will need you to complete a medical history questionnaire providing us with information that will help us to treat your individual needs. Please fill out our medical history questionnaire form and email to us before your appointment or print out and bring it with you to the appointment. Click here to download Medical History Questionnaire Form

SECURITY CODE
Please enter the code in the image in the field below
Security Code

PERSONAL DETAILS

Title

Name

Phone

Mobile

You are a

Heard about us by?

Would you like to:

Coupon/Promo Code:

PREFERRED DATE & TIME

TO REQUEST AN APPOINTMENT, PLEASE COMPLETE YOUR PREFERRED DATES AND TIMES.

CHOICE 1

Date

Time

CHOICE 2

Date

Time

CHOICE 3

Date

Time

What is your preferred time to be contacted?

QUESTIONS

To ask us a question about your dental health, use the box below and we will contact you with the best possible advice available from our surgery.

Questions related to your appointment

MEDICAL HISTORY QUESTIONNAIRE

If you are a new patient requesting an appointment, we will need you to complete a medical history questionnaire providing us with information that will help us to treat your individual needs.

Please fill out our medical history questionnaire form and email to us before your appointment or print out and bring it with you to the appointment.
Click here to download Medical History Questionnaire Form

SECURITY CODE

Please enter the code in the image in the field below

Security Code

Appointment

New and existing patients please click here to make an appointment online.

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Surgery Hours

Monday - Friday 9am - 5pm

Late Night Appointments available on alternate Tuesday and Thursday Evenings until 7pm

2 for 1 on Zoom Advanced Power Tooth Whitening - For one week only

What better way to brighten your week than with a whiter brighter smile. Bring a friend and get 2 treatments for the price of 1 at Synergy Dental Care. Call now to make an appointment

Limited Time Only

Denplan

A proud Denplan practice

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