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215, 215A Wood St, Middleton, Manchester M24 5RU
Invisalign
Dental Implants
Teeth Whitening
215, 215A Wood St, Middleton, Manchester M24 5RU
Call Us 0161 643 2428
Contact Us
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About Us
About Us
Our Team
Why Choose Us
Treatments
Teeth Straightening
Invisalign Aligners
Replace Missing Teeth
Dental Implants
Implant-Secured Dentures
The Dental Implant Journey With Us
Facial Aesthetics
Anti Wrinkle
Filler Treatment
Cosmetic Dentistry
Air Polish
Composite Bonding
Teeth Whitening
Veneers
General Dentistry
Examination
Emergency
IV Sedation
Bridges
Fillings
Extraction
Dentures
Crowns
Dental Hygiene
Root Canal Treatment
Wisdom Teeth Extraction
Mouth Guard
Minor Oral Surgery
Fluoride
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Contact Details
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Call Us 0161 643 2428
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Name of the person completing the form
*
Email of the person completing the form
*
Contact number
*
Which teeth would you like to fix?
Upper teeth
Lower teeth
Both
What are your main concerns with your smile?
*
Gaps in the my teeth
Crooked teeth
Sticking out teeth
Dark tooth
Worn teeth
Discoloured teeth
Old dentures
Missing teeth
Gummy smile
Bleeding gums
Other
Do you know when you would like to begin treatment?
*
Immediately
Within the next 30 days
Within the next 6 months
Not sure, just looking for more information
Please upload some photographs of your teeth to help our dentists assess your smile & advise on the best course of treatment.
Please note, below you can upload as many as five different photos. Take a look at this example image for some tips on taking the most helpful images. This is optional but would be helpful.
File 1
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File 2
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File 3
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File 4
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File 5
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Is there anything you feel we didn’t ask you?
Would you like to arrange a consultation?
*
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No
Please provide your consent for us to contact you.*
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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.
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Home
About Us
About Us
Our Team
Why Choose Us
Treatments
Teeth Straightening
Invisalign Aligners
Replace Missing Teeth
Dental Implants
Implant-Secured Dentures
The Dental Implant Journey With Us
Facial Aesthetics
Anti Wrinkle
Filler Treatment
Cosmetic Dentistry
Air Polish
Composite Bonding
Teeth Whitening
Veneers
General Dentistry
Examination
Emergency
IV Sedation
Bridges
Fillings
Extraction
Dentures
Crowns
Dental Hygiene
Root Canal Treatment
Wisdom Teeth Extraction
Mouth Guard
Minor Oral Surgery
Fluoride
New Patients
Nervous Patients
Patient Information
Fees
Finance
Patient Gallery
Testimonials
For Dentists
Contact Us
Contact Details
Request A Callback
Online Smile Assessment
Online Registration
Call Us 0161 643 2428
Contact Us
215, 215A Wood St, Middleton, Manchester M24 5RU