bg_01.gif

Reservation Form for Dental Trip

 

Please complete the form and we will get back to you promptly.

First Name :
Last Name :
Country :
Address :
Tel. No. :
Fax No. :
Email :
Appointment Date :
Trip Location :
Type of Treatment :
Laser tooth whitening Dental Implant
Porcelain Veneer
Crown & Bridge
Check up
Root canal treatment
Filling
Extraction
Cleaning Gum treatment
Invisalign Orthodontics(Braces)

Consultation
Enquiry :
 
   

Should you need help or more information, our personnel will be more than glad to give you the assistance you need.

Hotline : +6012 - 3061 246 (Victor Ng)
  +6016 - 2290 045 (Michael Lim)
+6016 - 2709 678 (Kyle Yong)
   

 

bg_03.gif