Private Patient Registration Form

At Highgrove Dental Care new patients are always welcome. If you are nervous or have any questions we are happy to help.

We are currently accepting private patients only

How to Register

Please fill in the below form
You will receive a text (normally within 72 hours) with some forms to fill in
Once you have completed the forms please call us on 0118 9871287 to arrange an appointment.
In the rare event that the form doesn’t work please call us on 01189871287 or email your details directly to reception@highgrovedentalcare.co.uk and a member of our team will be in touch.

Registration Form

Contact Details

Title*

First Name*

Last Name*

Email*

Date of Birth *

Mobile telephone number*

I am Interested in*

Composite Bonding
Implants
Whitening

Botox and Fillers
Hygienist
Dentures

Another Service (Please give details below)

required fields marked *
Powered by dB Masters Multimedia FormM@iler

Please note - this contact form should only be used for transferring information of a non-sensitive nature. If you wish to provide us with medical information or other potentially sensitive data, please contact us directly at the practice.

Email and text reminder service:

We offer an email and text reminder service to remind you of an appointment 48 hours in advance.

Meet the team

Arrange an appointment

Design by Dental Media

Mon	08.00 –12.30	01.30– 16.00
Tue	08.00 –12.30	01.30– 16.00
Wed	08.00 –12.30	01.30– 16.00
Thur	08.00 –12.30	01.30– 16.00
Fri	08.00 –12.30	01.30– 16.00