Self Referral for Patients

You can refer yourself to see Dr King

If you are concerned about your gum condition or have any questions please call 01225 87 44 44 and our reception staff will be pleased to help you. Alternatively please fill in the form below.

Self Referral Form

Contact Details

Name*

Email*

Address

Postcode

Telephone number *

Mobile telephone number

How you prefer to be contacted:

Comments

Enquiry

required fields marked *

Data Protection Privacy Notice for Patients (PDF document opens in a new window)

Please note - our site is running with an SSL certificate which means that the data is sent encrypted over HTTPS, this way personal information is secured during transmission (HTTPS is short for Hyper Text Transfer Protocol Secure). In addition our servers are housed in a secure UK data centre running under ISO27001 secure data management standards. If you require more information, please contact us by telephone on 01225 87 44 44 and we will advise.

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