Book Your Consultation

Fill in the information below and one of our team members will connect with you.

Patient Information
Full Name*
First
Date of Birth
Phone
Email*
Your Smile
From the list below, please select your main concern with your smile.*
upload photos (Optional)
To help expedite your consultation process, please upload a few photos of your smile so we can get a better idea of your treatment. If you have digital x-ray images from your dentist, please upload them here.
Max. file size: 100 MB.
Appointment Availability
preferred day*
- Select All
- Tuesday (Byron)
- Wednesday (West Five Smile)
- Thursday (Byron)
- Friday (West Five Smile)
preferred time*
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- Morning
- Midday
- Afternoon
INITIAL consultation type
If other, Please specify
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Phone
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