Contact Us Connect With Us Tel: 01223 507 750Email: info@stmarksdental.co.uk St Marks Dental6 Chapel StCambridgeCB4 1DY Get Direction Website Contact Us First Name * Last Name Phone * Email * Date of Birth Address NHS or Private Patient NHS Private Not Sure NHS Number Reason for Visit General Check-up Emergency / Pain Relief Cosmetic / Whitening Invisalign / Braces Dental Implants Other Please specify When did you last see a dentist / have a check-up? Have you had a hygiene appointment before? Yes No Are you exempt from NHS dental charges / on benefits? Yes No Which of these applies to you? Under 18 Under 19 and in full-time education Pregnant or had a baby in the last 12 months Income-based JSA Income-related ESA Pension Credit Guarantee Credit Universal Credit Valid HC2 Certificate Other Message Patient type (NHS / private) — Select — NHS Private Not Sure Receive health tips, special offers & more By submitting this form you understand that your data is processed in accordance with our privacy notice Submit