NHS Waiting List Form

Simply fill in the details using our secure NHS waiting list form with your details.

NHS Waiting List Online Form – Under 18s Only

NHS Waiting List Form

Please complete the form below if you wish to be added to our NHS waiting list at Hywel Samuel Golate.Once submitted below you will be taken to our Medical History Form where you can fill-out your details.

This form is for under 18s only.

"*" indicates required fields

Name*

First Surname

Email*

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Phone*

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Address*

Street Address Address Line 2 City/Town County Post Code Country

Marketing Consent

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From time to time Hywel Samuel Golate may wish to email you treatments, offers or news, which you may find useful to know.

Privacy*

I consent to having Hywel Samuel Golate collect my name, email and telephone

Hywel Samuel Golate take your data privacy seriously. You can view our Privacy & Data Protection policy here.

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Quick Contact

029 2037 1393

Golate Street , Cardiff

029 2183 3235

Loudoun Square Medical Centre, Butetown

0300 10 20 247

Dental Helpline. This service is available after 6pm week days, weekends and bank holidays.

Email Us

Email our team directly or use our secure contact form.

Opening Times

Mon – Thurs: 8.00am – 6.00pm Fri: 8.00am – 5.00pm

Early morning appointments are arranged with your dentist and on a private basis only.

NHS Waiting List Form

NHS Waiting List Online Form – Under 18s Only