If you would like to request an appointment for any of the treatments we provide at Durham Smile Clinic, please fill in the request an appointment form below.
First name *
Last name *
Email *
Telephone
Mobile
Postcode *
Treatment *Please select...Children's bracesComposite bondingDental bridgesDental implantsFacial aestheticsImplant secured denturesImplant supported bridgesOral surgeryRepairing teethReplacing TeethSingle dental implantSmile stylingHygiene serviceTeeth whiteningDental crownsDenturesTeeth straighteningRetainersReveal clear alignersInvisalign® clear alignersCeramic bracesFixed metal bracesDental health check-upsEmergency appointments
Are you a new or existing patient? *NewExisting
Appointment requested with: * Please select...No preferenceDan HeaneyAna MeheraPrabhat GurungSaul Pineiro AmadoMatt CelaireRand BahroBrian McClearySarah GillMelanie DixonJackie GleasonChristina Townsend
Confirmation
I understand that by submitting this form, it will be shared with the practice, following which a member of the team will contact me to discuss. View our privacy policy to learn more about how we use your data.
Submit
