Medical history

Leave this field blank

About You
Health Questions
Options & Signature

About you

Title

Last Name

First Name

Date of Birth

Occupation

Address

Post Code

Telephone

Email Address

If you have visited the practice within the past 3 months and there have been no changes please tick this box

Smile Stylist

Unit 4
53 King Street
Manchester
M2 4LQ

0161 832 2118

Monday08:00 - 16:00
Tuesday10:00 - 18:00
Wednesday10:00 - 18:00
Thursday10:00 - 20:00
Friday10:00 - 14:00
Saturday09:00 - 15:00
(one Saturday per month)
SundayClosed

Book a free consulatation

To help us better assess your treatment needs, upload a smiling selfie below:

Upload your selfie

I am 18 years or older.

I agree to Smile Stylist using my personal data to provide me with dental treatment.

I agree to Smile Stylist using my personal data to keep me informed about marketing offers and initiatives that may be of interest.

Full details of how we handle your data and how you can change your contact preferences can be found in our privacy policy.

or call us on

0161 832 2118

Monday 08:00 - 16:00
Tuesday 10:00 - 18:00
Wednesday 10:00 - 18:00
Thursday 10:00 - 20:00
Friday 10:00 - 14:00
Saturday 09:00 - 15:00 (one Saturday per month)
Sunday Closed