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REQUEST A QUOTE

Complete our online form to receive a quote. Alternatively, if you would like a free face-to-face consultation, contact us

In our quote we will give you an opinion about your orthodontic needs, treatment aims, brace options, timescales and an estimate of the cost of braces.

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All fields MUST be completed. This will take you around 20 minutes to complete.

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For any other enquiries please email info@chichesterorthodonticclinic.co.uk

Your Details

Are you undergoing any gum/perio treatment?
Do you have any outstanding dental treatment?

About Your Smile

Have you had braces before?
Rate your teeth out of 10 (1 being the worst)
What are your main concerns about your teeth?
Have you suffered any trauma to your teeth that required dental treatment?
Do you do any of the following?
Do you suffer from any of the following?

Upload images of your teeth (all required)

Hint: Please ask someone to help you so that the photos are clear and accurate. Copy the diagrams below as well as possible.

Selfie diagram
Upload File
Side of head diagram
Upload File
Teeth front view diagram
Upload File

Hint: Please use your fingers to move your lips out of the way.

Part open mouth
Upload File
Top teeth diagram
Upload File

Hint: Please open your mouth as wide as possible.

bottom teeth diagram
Upload File
Right side bit teeth clenched
Upload File
Left side bite teeth clenched
Upload File

Hint: Please use your finger or a spoon to pull your cheek out of the way so we can see how your back teeth fit together like the diagram.

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