Make your appointment

Please use our online booking preference form. Once we have your booking preferences we will contact you to confirm a time and date for a consultation.

Personal Details:

Name
Postal address
Telephone- business
afterhours
e-Mail
Are you an:
Existing patient
New patient
I would prefer an an appointment on:
Day	Select preferred day Monday Tuesday Wednesday Thursday Friday
Time	Select preferred time 8.00am 9.00am 10.00am 11.00am Noon 1.00pm 2.00pm 3.00pm 4.00pm
Reason for visit	Select reason for visit Routine examination New patient examination Routine tooth cleaning Clean with hygienist Gum problem Lost filling/broken tooth Toothache Wisdom tooth problem Cosmetic consultation Other
My appointment is	Urgency of visit Urgent Semi-urgent Not urgent (Urgent: today, Semi-urgent: next few days)
Please confirm my appointment by:
	e-Mail:Phone:Mail:
In order to help us help you we require the following information:
Your age:
Approximate number of fillings / crowns
Approximate number of teeth with root canal treatment
Approximate number of broken teeth/fillings or defects
Do you have sensitivity to heat, cold, pressure or sweetness?	Select... Yes No
When was your last dental examination?
Will this appointment be a second opinion?	Select... Yes No
Is this an Invisalign query?	Select... Yes No
If "YES", have you had orthodontics in the past?	Select... Yes No
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