Thank you for choosing to join one of our monthly dental membership plans. In order to complete your membership you will need to instruct your bank to set-up a Standing Order. This can be done electronically using the details on the downloadable form below. To download the form simply click on the ‘Download Form’ and click ‘Open’ or ‘Save’ when prompted to do so.

You will need to contact us to get your unique Patient Reference Number to add to the form or online standing order. Without this we will not know who the payment has come from. Just give us a call or drop us an e-mail.

If you do not use electronic or internet banking the form can be printed out, completed manually and sent to your bank via the post. This can however delay your application, so wherever possible please use internet banking as you should get instant confirmation.

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