Patient Registration interest form
Patients wanting to register with Gk Dental Implant & Cosmetic Clinic , 7 Great King St, Dumfries DG1 1BA,
United Kingdom
Name *
Email *
Address *
Phone number
Do you want to register as a Denplan (Monthly fee with discounts on further treatment) or Private patient (Pay as you go)? 
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Do you want to register additional family members? 
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Please describe any dental issues or queries you may have (optional)
When is the best time to call you?
How did you hear of us? (optional)
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