Complete this confidential form for your FREE Dental Assessment from one of our board certified dentists.

Please note: In many cases an OPG Xray will be required for a quote to be sent. We will inform you if this is the case. We have several centres that you can visit for this x-ray.

*A confirmed treatment plan can only be provided at the time you are examined by the Dentist. All quotations provided are estimated costs of the procedure requested. All estimates given are subject to change.

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Please note: In many cases an OPG Xray will be required for a quote to be sent.

Photos: please send in clear and close photos of your teeth.

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*Please note that a confirmed treatment plan can only be provided at the time you are examined by the Surgeon. All quotations provided are estimated costs of the procedure requested.  All estimates given are subject to change.