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? *

Which teeth do you want to fix?

Please choose ONE option. It is possible to treat your upper or lower teeth individually, as well as both at the same time. This information is crucial to your assessment.

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.

When do you want to start treatment?

Please choose ONE option. You are free to start treatment straight away, if suitable, or give yourself time to think it over.

How do you feel about the colour of your teeth?

Please choose ONE. As part of your assessment, we can consider tooth whitening after treatment with braces, if suitable.

How do you feel about the shape of your teeth?

Please choose ONE option. If you are concerned about the shape of your teeth, we can consider this during your assessment.

I am interested in:

Choose as many as you like but please choose at least one. It is important to consider your individual and unique needs as part of your assessment, including your preferences for particular treatment options.

What is your budget for the dental treatment you need?

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.