Patient application form

Are you looking to spread the cost of the treatment that you really want but don’t want to pay high interest rates?

At Dental Finance, we are able to offer a range finance options, including interest free, to Patients whose dental practice is affiliated to our scheme.

If your dentist is affiliated - no problem - simply download and print this application form, then complete it and return it to us as detailed on the form.

Alternatively, please telephone or e-mail us and we will send an application form to you.

If your dentist is not affiliated we will speak to the practice, without mentioning your name, to ascertain whether they would like to join. If they do not we can provide you with details of affiliated practices in your area that offer similar treatments.

Finance options up to 12 months are normally available at 0% APR. 
Interest is normally payable on repayment periods of more than 12 months – please contact us for details.


Finance is provided by a maximum of two finance providers with whom we have a commercial relationship. 

Representative example. Treatment cost £1200. Deposit Nil. Repayable by 12 monthly payments of £100. 
Interest NIL. Total sum repayable £1200. 0% APR Representative.