Please enter your details below to register for our upcoming Dental Consultation Day. Please note

• dental consultation in London costs GBP 30, but it is free in Budapest, or if you begin your treatment within 30 days, we deduct your consultation charge from your bill.
• panoramic X-ray scan maybe required if you don't have one, it will cost GBP 25
• we will call you on the next business day to arrange a suitable appointment
• your information is protected by our privacy policy.

Contact
Title
Forename
Surname
Occupation		(optional)
Address
City
Postcode
Telephone		or
E-mail		(optional)
Medical
Age
X-ray		Yes, I will bring my panoramic X-ray scan (less than 1 year old). Reliable information is required in order to provide a proper and accurate diagnosis and prepare the treatment plant. German panoramic X-ray machine is available in our London clinic.
Consultation
Preferred time		Saturday, 13 June 2009, AM Saturday, 13 June 2009, PM Sunday, 14 June 2009, AM Sunday, 14 June 2009, PM (optional)
		Yes, please email me relevant information and notification about future events.