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Institute of Dental Implants and Periodontics offer specialist services limited to dental implants and periodontal (gum) disease treatment (e.g. receding gums, gum infections etc.)

We do not offer general dentistry services for fillings, crowns and restoration, but work together with a network of general dentists to help coordinate a total treatment solution.

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New patient

Existing patient

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First name*

Surname*

Date of Birth*

Address*

Phone (Home)*

Phone (Work)

Mobile

Email*

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Type of consultation

Specialist consultation - implant / periodontal (gum) disease

Hygiene consultation (tooth clean and polish)

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Your current dentist (if you have one):

Name

Practice

Preferred appointment date & time

 

08:30 am09:00 am09:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30 pm2:00 pm2:30 pm3:00 pm3:30 pm4:00 pm

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Verification

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