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Welcome to Doctor George's Dental Clinic
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6
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1
Please insert your Name
First Name
Last Name
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2
Please insert your Phone Number
Please enter a valid phone number.
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3
Are you afraid of going to the dentist?
Absolutely no!
I'm mildly scared
Yes i got some fear
Honestly I'm scared to death
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4
When was the last time you did hygiene?
i don't remember, it was a long time ago
roughly a couple of years
More than a year for sure
6 months ago
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5
How can we help you ?
My kid needs some a very expert doctor
I'm in pain and I need the help of the doctor
I want to change my dentist
I want to have a bright smile and look better than ever
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6
What time do you prefer to be called?
between 8 am and 10 am
between 10 am and 1pm
Between 1pm and 4pm
Between 4 pm - 7 pm
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