Breeze Dental - Membership Information Question Title Question Title * 1. If you would like to join the Membership Plan the first step would be an examination at £70 paid over the phone at the time of booking. Would you like us to contact you to join our Membership Plan? Yes No Question Title * 2. If yes please provide us with the details below: Name Email Address Phone Number Question Title * 3. DOB Question Title * 4. How did you find out about us? Question Title * 5. Interested in? Dental health check Whitening Composite bonding Veneers Implants Crowns Question Title * 6. Do you require a downstairs surgery? Question Title * 7. How would you prefer us to contact you? Email or phone call? Done