Contact British Hungarian Medical Service

Title: Mr. Mrs. Ms.

First Name:

Surname:

Email:

Please provide your phone and/or mobile number
(country code - area code - phone number, e.g.: 44 - 123 - 4567890)

Phone No.: - -

Mobile No.: - -

If you have a promo code, please enter it below.
Promo code:

Best time to call: Please Select... anytime 9 a.m. - 12 a.m. 12 a.m. - 6 p.m. Saturday

The following fields are optional:

If you come for a consultation within a month, from date of submission of this form you can choose from one of the following free gifts: Dental hygiene treatment with 50% discount Home tooth whitening kit with 25% discount Tooth-coloured filling with 50% discount

Have you been assessed or examined by a dentist within the last 3 months? No Yes

If yes, do you have a recent dental treatment plan that you could send us? No Yes

Do you have a recently taken panoramic x-ray that you could send us? No Yes

Please check this box if you wish to receive monthly emails from BHMS with special offers and discounts. Yes No

Your age: Please Select... under 21 21 - 30 31 - 40 41 - 50 51 - 60 61 - 70 over 71

Town:

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What treatment are you interested in?

Where did you hear of our dental services?
Please select... Internet search Google ad-words Newspaper article Radio Recommendation Contact from Ágnes Tuba Contact from Elvira Kistamás I am an existing client Advert Seek.co.uk Hospital advert Easyjet magazine Yell.co.uk Other

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