Request An Appointment

If you require urgent or emergency service, please call our offices on 03 341 6800.
* Required field
First Name: *
Last Name: *
Street Address: *
Suburb *
Email: *
Home Phone: *
Work Phone:
Mobile Phone:
How did you hear about us?
Service you are interested in
(please tick all that apply)
Whitening
Dental makeovers
General & Cosmetic Dentistry
Other (please specify below)
Comments:
*Please note: conditions apply - please see conditions in store.
Your entry is validated at the end of your first examination.