New Patient Registration Form

Please complete the information below to be added to our new patient waiting list. You will be contacted by one of our friendly reception team to invite you for a first appointment as soon as a place is available at your chosen practice.

Submission of this form is confirmation that we have received your details, so we kindly ask you await our phone call and please don’t contact the practice by telephone beforehand.

All the best,


The Temple Practice
West Park Dental
West Yorkshire Dental Implant Centre

Please note: Each person signing-up requires a unique email address. Re-using an email address will result in only the most recent submission being accepted. Previous submissions will be deleted if an email is re-used.

If you wish to add a family member without their own email address, such as a child, please enter an email address from a parent or guardian which has not been previously used, or alternatively telephone the relevant practice to let them add the child manually to our records.

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Please note: To help speed up your registration with us, please take a moment to read and fill in our Dental Therapist Consent Form using the link below.