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DENTURE REFERRALS FORM

Please provide us with information about your personal details and general health to help us treat you safely. Do not answer any questions you do not understand. You will have the opportunity to discuss any queries with your dentist who will be happy to answer any of your questions. All information will be kept strictly confidential by the people caring for you.

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Please tick if you would like to receive information about our services, products and information which we feel might be of interest to you by:

By completing this section you consent to the practice contacting your next of kin in the event of a medical emergency:

Next of Kin

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Please tick all that apply and list any details in the notes field provided.

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CONTACT US

T: 0113 469 1895

E: smiles@thedenturespa.com

Address: 

1 Corner House Shops, Moortown Corner,

Leeds, LS17 6LD

BUSINESS HOURS

Monday: 24 Hours

Tuesday: 24 Hours

Wednesday: 24 Hours

Thursday: 24 Hours

Friday: 24 Hours

Saturday and Sunday: 24 Hours

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DING DENTAL LABORATORIES LIMITED, registered as a limited company in England and Wales under company number: 08453609.

Registered Company Address: 345 Harrogate Road, Leeds, West Yorkshire, LS17 6PZ.

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