Patients wishing to register will be asked to complete a new patient questionnaire, once we have recieved your application you will have to telephone the practice to make a New patient Registration Appointment with a practice nurse. If you change your name, address or phone number, please let our receptionist know. If you move outside the practice area, it will be necessary for you to find a new doctor in your new area.

Download an application form (PDF 297KB)  


You may need to download Adobe Acrobat Reader to edit and save your form. For more information on saving forms, visit the Adobe website.

Once your application form is completed please email to please note this email address is for Registration Forms only. If you are unable to access an application form in this way please contact the surgery by telephone on 01236 422950 and an application form will be sent out to your address.

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Bonnar & Co Kirkshaws Dental Practice