Personal Information


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.
2.Left Side
3.Right Side