If you would like to request an appointment for any of the treatments we provide at Durham Smile Clinic, please fill in the request an appointment form below.
First name *
Last name *
Email *
Telephone
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Postcode *
Treatment *Please select...BridgesChildren's bracesComposite bondingDental ImplantsImplant Secured DenturesMultiple Dental ImplantOral SurgeryRepairing teethReplacing TeethSingle Dental ImplantSmile stylingHygieneTeeth whiteningCrownsDenturesTeeth straighteningRetainersReveal clear alignersInvisalignCeramic bracesFixed bracesGeneral dentistryEmergency appointments
Are you a new or existing patient? *NewExisting
Appointment requested with: * Please select...No preferenceTim DaviesSaul Pineiro AmadoDan HeaneyAna MeheraMatt CelairePrabhat GurungSarah GillMelanie DixonJoanne KirkbyJackie GleasonOlivia DaleKelcie MorrisChristina Townsend
Confirmation
I understand that by submitting this form, it will be shared with the practice, following which a member of the team will contact me to discuss. View our privacy policy to learn more about how we use your data.
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