DR RONEL PODDE INC
Home
About
Services
Dental Services
>
Single Visit Dentistry
Basic Dentistry
Oral Hygiene and Preventative Dentistry
Specialised Dentistry
Peadiatric Dentistry
Orthodontics
Sports Dentistry
Digital x-rays
CBCT Scans
Snoring and Apnea Treatment
Dr Green Apple Shop
Cosmetic Services
>
Teeth Whitening
Botox
Fillers
Excessive Sweating Treatment
Digital Services for Dental Practitioners
Dental Tourism
Before & After
Latest News
Facilities
Contact
WhatsApp
PATIENT INFORMATION
*
Indicates required field
Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
How did you hear about this site?
*
Internet Search
Advertisement
Friend
Other
If Other please specify:
*
MEDICAL HISTORY
Have you had any surgery in the last 12 months?
*
No
Yes
If you've had surgery in the last 12 months, please provide the details here:
*
Have you had any dental procedures performed in the last 12 months?
*
No
Yes
If you've had any dental procedures performed in the last 12 months, please provide the details here:
*
HOW CAN WE HELP?
Please explain your dental problem and include any treatment previously received for the problem.
*
WHAT ARE YOUR EXPECTATIONS?
Please explain your expectations of the dental treatment?
*
PHOTOS
Upload photos that gives a clear view of the teeth you'd like treated.
Front view of clenched teeth
*
Max file size: 2MB
Side view of clenched teeth
*
Max file size: 2MB
Any photo of your teeth that you think your dentist needs
*
Max file size: 2MB
PANORAMOGRAM
Upload the digital panoramogram file you received from your local dentist
*
Max file size: 2MB
GENERAL
Which package are you interested in?
*
Silver
Gold
Platinum
What are your preferred travel and treatment dates?
*
Is there anything else you'd like us to know?
*
Submit
