Registration Form

Please email us at info@craiglockhartdental.co.uk or use the online form below.
Fields in bold are required.

Name
Address
Tel Numbers
Email Address
DOB
Appointment	When would you like an appointment? Select a Day Monday Tuesday Wednesday Thursday Friday What time is best for appointment? Select a Time Morning Afternoon
	How do you wish to be contacted?
Message
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	Note: Your registration will be confirmed by the practice.

If you are over 18 years of age you can register by completing this form and we will complete all the necessary paperwork ready for your signature. Registration will be complete when the necessary paperwork is returned signed to the practice and the practice confirms registration. An examination appointment must be carried out before we are allowed to register children. On receipt of this form we will contact you to arrange an appointment to suit you.

Email Us

Please email us at info@craiglockhartdental.co.uk or use the online form below.
Fields in bold are required.

Full Name
Address
Tel (day)
Tel (evening)
Mobile
Email
	How did you find us?
Message
I consent to my personal data being collected and stored as per the Privacy Policy.
I consent to my personal data being collected and stored for the purpose of marketing communications.
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How to Find Us

Feedback & Complaints

Please email us at info@craiglockhartdental.co.uk or use the online form below.
Fields in bold are required.

Name
Email Address
Your visit was on
Overall rating for this dentist
I would recommend this practice to a friend
I would not recommend this practice
I do not wish to express an opinion
How satisfied were you with the time you had to wait for an appointment?
does not apply Very satisfied Fairly satisfied Neither satisfied nor dissatisfied Fairly dissatisfied Very dissatisfied
Were you treated with dignity and respect by staff at the practice?
does not apply At all times Mostly Sometimes Rarely Never
How satisfied were you that the dental practice involved you in decisions about your care?
does not apply Very satisfied Fairly satisfied Neither satisfied nor dissatisfied Fairly dissatisfied Very dissatisfied
How satisfied were you with the information given by the practice on the cost of your treatment?
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How satisfied were you with the outcome of your treatment?
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What I liked
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What could have been improved
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Any other comments
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Please summarise your overall experience in a single sentence
of 80 remaining
I consent to my personal data being collected and stored as per the Privacy Policy.
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