Call us on 01962 864 655

23 Stockbridge Road, Winchester, SO22 6RN

What is your first name? *

What is your last name?

What is your email? *

What is your phone number? *

What is your main problem?

Please choose ONE option. Depending on your circumstances, there are various potential treatment options.

What is your main concern?

Why are you looking for a solution and what has motivated you to take this first step? Choose as many reasons as you like.

What is your budget for the dental treatment you need?

I want to start treatment:

Please choose ONE option. You have complete freedom over your treatment, including when you wish to start.

How nervous are you about the thought of dental treatment?

Please choose ONE option. Most people we treat are very nervous. If we know before hand, we can specifically help with this.

Pictures are worth a thousand words and this is especially true in dentistry. We will provide guides for each photo.

Please note that this is optional. Photos will help your assessment but they are not required.

Front Facing Smile

Give a big wide smile, showing your teeth, and look directly at the camera. Take a photo of your teeth.

Bottom Teeth

Open your mouth wide and tilt your head down. Take a photo of your bottom teeth.

Top Teeth

Open your mouth wide and tilt your head back. Take a photo of your top teeth.

Left Facing Teeth

Give a big wide smile and ask somebody to take a photo of the left side of your face.

Right Facing Teeth

Give a big wide smile and ask somebody to take a photo of the right side of your face.

Have we forgotten anything? If so, please, in a few words, let us know of any information you feel is important.

Please choose ONE option. Your treatment is controlled entirely by you - knowing when you want treatment is just as important as anything else.