Unregister request

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Disclaimer

If you do not wish to be seen anymore at the Orthodontic Practice at Battersea or to be contacted by us, please provide a reason and your details below.

Your request will be processed only if you provide and submit required details. Confirmation and copy of this request will be sent to you by email.

Please bare in mind that after unregistering in order to be seen you will have to request a rereferral from you General Dental Practitioner (Dentist) to be sent again to us. Please note that a rereferral does not guarantee any further treatment under the NHS (National Health Service).

I do not wish to arrange any further appointments with the Orthodontic Practice at Battersea

because I’m or have been under treatment with another practice

I do not wish to arrange any further appointments with the Orthodontic Practice at Battersea (copy)

because I have moved away from the area

I do not wish to arrange any further appointments with the Orthodontic Practice at Battersea (copy) (copy)

I do not wish to provide any reason for my decision

I do not wish to arrange any further appointments with the Orthodontic Practice at Battersea (copy) (copy) (copy)

I do not wish to be contacted by the Orthodontic Practice at Battersea in the future

Please choose all applicable, at least one option needs to be selected.

The Orthodontic Practice at Battersea

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