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Clinic
- Clinic
About You
- About You
Payment
- Payment

Select Clinic *

Select Dentist *

Payment start date

Select Membership Plan

Synplan 1 Adult
Comprehensive Dental Care
2 Examinations Annually
Comprehensive X-Ray Coverage
Two Professional Cleans Annually
VIP Shopping Discounts
Unlimited Value Discount
£10.00
/per Month
(Please note that an administration fee of £10.00 will be charged with the first payment of each membership)
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First Name *

Surname *

Date of Birth

Email address *

Phone number *

Address *

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By clicking here, I state that I have read and understood the terms and conditions.

Membership

These are the details that the company has on record about you. Please verify that these are correct and if so, enter your Account Number and Sort Code.

First Name

Surname

Email address

Account Number

Sort Code

Please note that an administration fee of £10.00 will be charged with the first payment of each membership

By providing your bank account number and sort code to Synergy Dental Clinic and confirming this payment, you are authorising Synergy Dental Clinic and Mollie, our payment service provider, to send instructions to your bank to debit your account and your bank to debit your account in accordance with those instructions. You are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited.