top of page

Implant Enquiry Form

​​Dental implants are a specialized procedure that requires expert training to ensure optimal results.

 

While many practices refer patients to external specialists, our group has multiple implant specialists in practice, so you can receive comprehensive care for your missing teeth all in one place, with no additional referrals or trips to other dentists.​

​​

​

Interested in booking an Implant Consultation? Fill out our Implant Enquiry form below and a member of our Team will contact you about an Implant Consultation.

Who are you registering interest for?
Myself
My children (my own or those I am a guardian of)
On behalf of someone else

If registering for children or on behalf of someone else, please fill out this form as though you are them.

Please provide their details, not your own.

Birthday
How would you rate your general dental health?
Excellent
Good
Fair
Poor
Have you experienced any of the following (select all that apply)?
What is your primary reason for considering dental Implants?
Missing teeth
Loose dentures
Improving appearance
Difficulty chewing
Other
Have you had an Implant before?
Yes
No
How long have you had missing or damaged teeth?
Less than 6 months
6 months - 1 year
1 - 2 years
More than 2 years
Are you currently experiencing pain or discomfort in your mouth?
Yes
No
If yes, how would you describe the pain / discomfort?
Mild
Moderate
Severe
bottom of page