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| Full name |
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| Telephone |
Please give us at least one contact number |
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| Please give us
a short description about the dental treatment you need
or ask a question below. |
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| Which way you prefer to be
contacted? |
(first choice) |
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(second choice) |
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| If you prefer to
be contacted by mail, please provide your address below |
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| Second Line |
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| County |
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| Town |
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| Post code |
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| How did you hear about us? |
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Help us to improve
Answering the following questions
you would help us to improve our service and make accessible
for more and more people, so they also could benefit from
the word class technology of our dentistry, professionalism
of our dentists and from the affordable prices. If you don't
wish to complete the following form please click "Send"
now and thank you for contacting us. |
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| How often have you seen your
dentist during the last 5 years? |
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| What kind of dental
care do you use? |
| Tooth brush |
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| Tooth paste |
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| Mouthwash |
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| Tooth whitening |
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| Dental floss |
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| What would be your
main reason to go under cosmetic dentistry? Please put the
following answers in order according to your preferences. |
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| First |
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| Second |
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| Third |
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| Fourth |
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| How much have you spent for
your last private dental treatment? |
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| In what currency? |
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| What quote have you received
for your current dental needs? / Or if you haven't received
any, what do you think the quote would be? (in the
same currency) |
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| What savings would you be looking
for if you traveled for dental treatments abroad? |
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| Your other reason for traveling abroad
for dental treatments apart from savings |
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| How long you would prefer to
stay abroad while you are treated? |
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| What type of hotel / accommodation
would you be interested in during your stay? |
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| If you think you
have a friend, who would be interested in our services,
please send us his/her e-mail address, and we will send
a short e-mail to introduce our company. (We will refer to
you, but we will not send more than one e-mail,
and will not use any detail for any other purposes) |
| Friend's e-mail address |
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| Thank you for taking
the time to fill out our form, and helping us to impove
and fine tune our services. |
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