Register online

Simply fill out the form below and click submit and we’ll be in touch shortly. Alternatively you can pop into the surgery.

We take patients from Bournville, Edgebaston, Harborne, Mosley, Sellyoak, Kings-Norton, Barnes Green, Alve Church, postcodes B29, B30 and more. Phone the surgery for more information on (0121) 472-0189

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Register for Bournville Village Dentist
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First Name
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Last Name
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Date of Birth
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GenderPlease Select
Contact Phone Number
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Preferred Time to Callpick one!
How long since you last visited a dentist? We won't tell you off. Promise
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Which treatments are of interest to you?pick one!
CommentsAre there any other aspects of your health that you feel we should know about?
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Consent of Contact Details

*We use your name, phone and e-mail address to contact you, confirm your appointment, confirm an online registration, or to confirm or cancel a service which you have previously booked with the Bournville Village Dental Practice

By clicking on the submit button below, you are confirming that all the information you have provided is correct.

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