Private Adult Registration – Montreal Dental Care

Adult Registration Form for Private Dental Care

Please complete the form below to register your interest in private dental care with Montreal Dental Care.

Title *

Date of birth *

First name *

Surname *

Full address *

Mobile number *

I consent to receiving appointment reminders by SMS.

Email address *

I consent to receiving appointment reminders by email.

Patient Agreement

Please read the following information carefully before submitting your registration form.

You will be asked to pay a £25 deposit at the time of booking; this is to secure your first appointment time. We reserve the right to retain this fee in the event of late cancellation or failure to attend.

All further treatment costs will be explained to you by the dentist prior to booking your next appointment.

We will ask for 50% of the total treatment cost at the time of booking your next appointment. We reserve the right to retain this fee in the event of less than 24 hours' notice of cancellation or failure to attend the appointment.

We accept payment by cash, debit card or credit card.

There will be no charge for changing your appointment provided that we are given at least 24 hours' notice.

I have read and accepted the above Patient Agreement.

I understand that my deposit will be retained if I do not provide at least 24 hours' notice to cancel or rearrange an appointment, or if I fail to attend the appointment.

What happens next: The practice will contact you within 24–48 hours of receiving your registration form.

We will use the information you provide to process your registration and contact you regarding your dental care. Please see our Privacy Policy for information about how Montreal Dental Care uses and protects your personal information.

I confirm that I have read and understood the Privacy Policy.

Adult Registration Form for Private Dental Care

Patient Agreement

Get in touch

Quick Links

Location Map