www.Fiaclóir.com
Make an appointment online by filling in the details below.
You will be contacted by phone or e-mail within 24 hours.
Last Name:
First Name:
Address:
Address:
Address:
Phone:
E-Mail:
Preferred Day:
Monday
Tuesday
Wednesday
Thursday
Friday
Month:
January
February
March
April
May
June
July
August
September
October
November
December
Date:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Preferred Time:
9.30
9.50
10.10
10.30
11.10
11.30
11.50
12.10
12.30
2.00
2.20
2.40
3.00
3.20
3.40
4.20
4.40
5.00
Alternative Day:
None
Monday
Tuesday
Wednesday
Thursday
Friday
Month:
None
January
February
March
April
May
June
July
August
September
October
November
December
Date:
None
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Alternative Time:
None
9.30
9.50
10.10
10.30
11.10
11.30
11.50
12.10
12.30
2.00
2.20
2.40
3.00
3.20
3.40
4.20
4.40
5.00
Any other details:
This information is transmitted by e-mail and therefore its security cannot be guaranteed. If you do not wish to use this form please contact the Practice by phone.
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© Paul O'Dwyer BDS (NUI)