I am a patient

Two short steps.

What is bothering you?

Tick whatever applies. You do not need to know which treatment you need — the student works that out at the examination.

Urgent

Pain

Teeth

Gums

Missing teeth and dentures

Other

Who is this request for?

Required if you ticked nothing above. Otherwise optional but strongly recommended — it is the first thing a student reads, and what they judge whether they can take the case on. Say how long, whether it hurts, which tooth. Do not put a phone number or email here.

When you can come

Only tick the times you can genuinely make. A student checks these against their weekly timetable and sees straight away whether they can take you — so three accurate boxes beat ten maybes.

Tick the exact day-and-time combinations you can make

These start times are approximate — the faculty keeps its own timetable and the student confirms the exact hour. Tick when you could usually come.

08:0010:0011:3013:0014:3016:00MonTueWedThuFri

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