To make an appointment with Dr Tariq Drabu and any of his team at Langley Dental Practice, please complete the form below with all of your personal details. Please try and complete as many details as possible. All your details are 100% secure and will not be shared with any third parties.

Your full name: *
Your address: *
Telephone Number: *
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Which treatments are you interested in? (please select at least one treatment option)
 Teeth Whitening
 Treatment under sedation
 Dental Implants
 Teeth Straightening
 Tooth Coloured Fillings
 Veneers/Smile change
 General Dentistry
 Minor oral surgery
 Botox/Facial fillers
 I would like to arrange an appointment
 I would be able to attend at short notice if an appointment becomes available
Please give details of the type of treatment that you are interested in and your available appointment times:
Where did you hear about us?
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