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Patient Registration
Rishton Dental Practice, Wilmslow Practice, and O’ Farrell & Staunton Practice
We have now reached capacity for NHS Patients at Pendlebury Dental Practice.
First Name
Last Name
Email Address
Phone Number
Date of Birth
Address
Post Code
Are you Exempt from payments?
Select one...
Yes
No
If you are Exempt, which reason are you?
None...
Expecting Mother
Nursing Mother
Income Support
HC2 Certificate
HC3 Certificate
Job Seekers - (Income-based)
Tax Credit Certificate
Pension Credit Guarantee
Prisoner
Income Related ESA
Universal Credit
Please select a practice
Select one...
O’ Farrell & Staunton
Rishton
Wilmslow
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