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Register

If you are a patient who is resident within our catchment area then you are welcome to register with our Practice.

If you would like to register with the surgery then please complete a GMS1 Registration form and New Patient Questionnaire and return it to reception. These forms can be obtained from reception or printed from the links below.

When returning the forms to the practice you will need to bring proof if ID and address with you.

Under 18's New Patient Questionnaire

GMS1 registration form

New Patient Questionnaire

Market House, Market Road, Wickford, Essex, SS12 0AA
Website supplied by Oldroyd Publishing Group
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Wickford Dental Health Centre
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