Fax number:

Address

Purpose of dental visit

Bleaching/whitening

Bonded veneers

Cosmetic dentistry

Broken or missing teeth

Cleaning & check-up

Dentures

Crowns, caps & fixed bridges

Examination

Fillings

Implants

Porcelain laminates/veneer

Night/Bite plates

Temporary fillings

Wisdom teeth

Further information:

Preferred days and times of appointments

Office hours: Monday - Friday, 9:00 am - 6:00 pm (last appointment please give several choices):

Preferred time of day

Preferred days and or dates

Appointment confirmation

Welcome to the family cosmetic and dental practice. Please note that you are responsible for settling the account immediately and then claiming from your medical aid. We would appreciate payment on the day of treatment. Failure to do so will result in additional administrative and interest charges. Quotations can be obtained before commencement of treatment.