The Leading Specialist Dental Negligence Solicitors in the UK
Complete our short online claim form and find out if you are eligible to claim thousands of pounds in dental negligence compensation....
Country *We are only able to process claims for dental negligence that occurred in England or Wales England / WalesElsewhere Name * ? Your name will be used for customer service purposes.
Does the potential claim relate to treatment YOU have received? YES - please go to section 2 'Treatment Information'NO - please fill in the section below
What is your relationship to them?
Have you got their permission to speak to us? YesNo
What is the format of their permission? (If written please attached at the end of the form) WrittenVerbal
What treatment are you complaining about? * ? This information will be used solely for the purpose of assessing whether you have a potential dental claim.
Location of Dentist/Town*
What injury did you suffer? * ? We collect this information for the purpose of assessing whether you have a potential dental claim. What treatment do you now need? * ? We collect this information or the purpose of assessing whether you have a potential dental claim.
When did you find out there was a problem (approx. date) *
How did you find out there was a problem? * Have you attended regular dental check-ups in England or Wales in the last 2 years before the treatment you are complaining about? yesno
I confirm that the information contained within this questionnaire is true to the best of my knowledge and belief. *
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I have read and agreed the privacy policy *
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Country *If your enquiry is about a claim, we are only able to process claims for dental negligence that occurred in England or Wales England / WalesElsewhere Name * ? Your name will be used for customer service purposes.
Enquiry *
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