Happy To Help You Test

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• About You

• Your Name*
  
  First
  
  Last
• Your Email*
  
• Whats your referred method of contact?
  • Email
  • Phone
  • No Preference
• Your Phone Number?*We use mobile phone numbers to uniquely identify each patient instead of their names as we increasing have patients with the same name.
• Preferred time of contact?
  • Morning (9am -12pm UK time)
  • Afternoon (12pm-5pm UK time)
  • Evening (5pm -7pm UK time)
  • Anytime
  • Don’t Call
• Date Of Birth*
  
  Date Format: DD slash MM slash YYYY
  We know it’s rude to ask, but we need to know by law this for medical reasons…
• Your Nearest Airport*Filling this out will help us to make exact travel / airline & cost information for you.
  Airport pick-up / drop-off service is always free of charge 🙂
• Who recommended you to us?*Patients referred to us by current or former patients receive priority booking options.

• About Your Dental Treatment

• Your Desired Dental Treatment*
  • 
    Dental Implants
  • 
    “All On 4” entire upper or lower jaw replacement
  • 
    Crowns (Caps) or Bridges
  • 
    Veneers
  • 
    Root Canal Treatment
  • 
    Tooth Extractions
  • 
    White Fillings
  • 
    Tooth Whitening
  • 
    Dental Hygiene / Periodontal Treatment

  please click only those dental treatments that really apply to you, otherwise you’ll get a really long email reply from us…
  …and we may be up all night writing out detailed quotes for each of the dental treatments that you don’t need 🙂

• How many dental implants (inclusive of implant abutment and crown) do you expect to have?
• How many single crowns or bridge points do you need?(bridge points are counted by number of teeth or gaps that the bridge includes)
• How many veneers do you need?Typically, 4-8 crowns / veneers across the top front and bottom teeth are all that is needed to create a new bright symmetric smile. A good way to check is by smiling in front of the mirror, and checking how many unsightly, crooked, discoloured or uneven teeth are visible. This is the number of teeth that will need crowning / veneering.
• How many root canals do you need?
• How many white fillings do you need?
• Do you need any tooth extractions? If so how many?IMPORTANT: If these are wisdom teeth that you need extracting, please let us know in the box below…
• The "all on 4" dental implant solution is:
  • to replace only my UPPER jaw
  • to replace only my LOWER jaw
  • to replace BOTH the upper and lower jaws
• Anything else that you want us to know?
• Need to add a photograph, x-ray or quote from another clinic?