CLOCK PLAN

Your Dental
Healthcare Plan

£15
/month

Total care & complete satisfaction, see below what our plan includes:

2 x Dental Examinations per year
2 x Deep Scale & Polish per year
20% Discount on any treatment excluding Orthodontics & Implants
Worldwide Accident & Emergency Insurance & More!

Maintenance Dental Plan

– Please complete the Agreement in BLOCK CAPITAL letters –

Your Details

"The Patient"
DD slash MM slash YYYY
If known

Your Direct Debit

The Direct Debit Guarantee • This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society. • If the amounts to be paid or the payment dates change Insurance Broking Finance Ltd will notify you normally 10 working days in advance of your account being debited or as otherwise agreed. • If an error is made by Insurance Broking Finance Ltd or your Bank or Building Society, you are guaranteed a full and immediate refund from your branch of the amount paid. • You can cancel a Direct Debit at any time by writing to your Bank or Building Society. Please also send a copy of your letter to us. Insurance Broking Finance Ltd are authorised and regulated by the Financial Conduct Authority. Registered in England No. 04981657. Registered Office: Affinity House, Bindon Road, Taunton, TA2 6AA

Your Declaration

Once you submit this application, a member of our team will process your information and will send you a draft of your final contract. This contract must be signed and sent back to us.
DD slash MM slash YYYY

To register as a patient please call us on
01305 785325 or pop in for a consultation.