Online Registration

NOTE: We are currently able to accept children (under 18) on the NHS and adults privately.

Name *

First

Last

Date Of Birth (DDMMYYYY) *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Email *

Phone *

Do you need an Interpreter

Yes
No

What language?

Best time to contact *

Are you intending to register other member of your family with the practice: *

Yes
No

Other Member (Name - DOB - Contact Number) *

Appointment type: *

Urgent
Routine

Do you have any of the following issues: *

Other issues details

I would like more information on: *

How did you hear about our practice: *

Please provide your consent for us to contact you.* *

I accept
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Please understand that by submitting this form, you consent to future contact from Langley Dental Practice. This includes both marketing and non-marketing communications by phone and or email. We will never sell your personal data under any circumstances & you may opt-out of receiving our communications at any time.

Online Registration

NOTE: We are currently able to accept children (under 18) on the NHS and adults privately.

Dentist in Middleton, Manchester

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Last Updated December 2023 ¦ Copyright © 2023 ¦ Dental Website Designed by iDesignDental

Monday	9:20 AM - 5:30 PM
Tuesday	9:20 AM - 5:30 PM
Wednesday	9:20 AM - 5:30 PM
Thursday	9:20 AM - 5:30 PM
Friday	9:20 AM - 4:00 PM
Saturday	By Appointment
Sunday	Closed