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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
Please note, our clinic days are Tuesday, Wednesday & Thursday only.

Your Details

Date of birth
Day
Month
Year
Are you undergoing any gum/perio treatment?
Yes
No
Do you have any outstanding dental treatment?
Yes
No

About Your Smile

Have you had braces before?
Yes
No
What are your main concerns about your teeth?
Have you suffered any trauma to your teeth that required dental treatment?
Yes
No
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.

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

Hint: Please open your mouth as wide as possible.

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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