Name
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First Name
Last Name
Email
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Mobile
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Please tick any of the following which concern you
l am unhappy about the colour my crowns or fillings
l am concerned about bad breath
I have gaps in my smile
My dentures are uncomfortable, and they look/feel like dentures
I am worried about the cost of treatment and how to pay for it
My gums bleed when I brush them
My teeth are not as bright and white as I would like them to be
Some of my teeth are chipped or misshapen
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Feel free to tell us a bit about any dental issues you are experiencing - we will discuss this with you in more detail.
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