Private Payment Plan Survey

Currently, Wedgwood House dental practice does not offer a private payment plan. This survey is to understand the level of interest from our patients whether they would like to join a monthly payment scheme to spread the cost of regular services such as dental check-ups and hygienist sessions.

Private Payment Plan Survey

Name:*

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Address:*

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E-mail address:*

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Mobile number:*

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I am a private patient (dentist or hygienist) of WHDP or have joined the private dentist waiting list.

I understand that this survey does not mandate that WHDP introduce a payment scheme.

Tick here if you would like to have a payment plan to spread-out private fees each month.

I am over 18 years of age and a UK citizen. I hereby agree that my personal data entered in the Private Payment Plan Survey Web Contact Form will be stored electronically by Wedgwood House Dental Practice, and will be processed and used for the purpose of establishing contact and assess overall customer demand for a payment scheme at Wedgwood House Dental Practice (WHDP). I am aware that I can revoke my consent at any time, though deletion of dental records is prevented by the UK Data Protection Act 2018.The dental practice reserves the right to exclude requests from ex. (inactive) patients.*

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Thank You! We will take your response into consideration.

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Private Payment Plan Survey

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