Online Booking

REFER A PATIENT

Simply fill out the form below and we will be in touch as soon as we can.

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Luxury Service & Surroundings

EXPERT CARE THROUGHOUT

Referral form

Patient Details

Patient Full Name(Required)

First Last

Patient Full Address

Street Address Address Line 2 City Postcode

Patients Telephone(Required)

Petient Email Address(Required)

Email Address Confirm Email Address

Relevant Medical History

Service Required

Tooth/Teeth to be treated

Patient informed of approximate cost:

Yes

No

Details of treatment required:

Referring Dentist Details

Dentist Full Name(Required)

First Last

Practice Full Address

Street Address Address Line 2 City Postcode

Telephone(Required)

Email Address(Required)

Email Address Confirm Email Address

Date: 06/10/2026

Signature

I have obtained consent to this referral from the patient or parent/guardian following my consultation to discuss their treatment options

Yes

No

VISITING FIVE DENTAL

Yes, we have on-site parking available for all patients, so there's no need to worry about finding a space nearby.

Yes, our practice has disabled access and a dedicated disabled toilet on-site. If you have any specific accessibility requirements, just let us know ahead of your visit and we'll be happy to help.

If you're experiencing a dental emergency, please call us directly on [phone number] and we'll do everything we can to see you as quickly as possible.

FIND US

FINDING THE PRACTICE

Five Dental is located in Baldwins Gate, Newcastle-under-Lyme, with easy access from the surrounding area.

ADDRESS

Alma House, Baldwins Gate,
Newcastle-under-Lyme, ST5 5DA

EMAIL

info@fivedental.co.uk

"A space designed for calm"

From routine check-ups to advanced dental treatments, our team is here to support you. Contact us today and we’ll help you find the right appointment or answer any questions you may have.

Book Consultation

Phone : 01782 551551
Email : info@fivedental.co.uk

Alma House,
Baldwins Gate,
Newcastle-under-Lyme,
ST5 5DA

OPENING HOURS

Monday - Friday : 9:00am - 5:00pm

Information

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We're proud to be registered with and regulated by the CQC, England's independent health regulator, so you can trust our standards of care and safety.