ONLINE CONSULTATION

Personal Information

Appointment


I would like to arrange an appointment prefered date and time for appointment

Consultation Request


Please give us as much information as possible so we can give you the most appropriate advice.
1. Description the postion of problem tooth/teeth by using 2 digit number from diagram *
2. Photos of your teeth as many views as possible, Full mouth x-ray or the x-ray of problem tooth/teeth and any other questions.
Attach image must be gif, jpg or png file in 8 MB in total only
3. Innital planing from local dentist (If you have one)

Personal Information



Patient Background


1) Have you ever had braces before? *
2) Have you ever had Invisalign consultation before? *

Major problems *

Attach your photos


as example for more accurate treatment plan.
1.Front
2.Left Side
3.Right Side
TOP

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