Name*

Email Address*

Contact Number*

Are you a new or existing patient?*
New PatientExisting Patient

Are you registered under any CHAS schemes or Corporate Insurance policies?*
NoNot SureBlue CHAS cardOrange CHAS cardPioneer Generation cardMerdeka Generation cardAIA InsuranceIHP InsuranceAlliance MedinetFullerton Healthcare (SIA)Allianz CareSAFRA cardOther

Preferred Date* (Please note that appointments can only be booked 6 months in advance.)

Preferred Time*
10:00am10:30am11:00am11:30am12:00pm2:00pm2:30pm3:00pm3:30pm4:00pm6:00pm6:30pm7:00pm7:30pm8:00pm

Preferred Branch*
Tampines Plaza201D Tampines827 Tampines821 TampinesBedok Mall26A Chai Chee18 Bedok South59 New Upper Changi84 Bedok North85 Marine Parade684 Hougang681 HougangSingapore Management UniversityNorthpoint CityCentral Patientcare (Yishun)The Dental Practice @ BedokThe Dental Practice @ TampinesThe Dental Practice @ Paya Lebar

Service*
Braces ConsultationBraces RetieChairside Whitening ConsultationCrownDenturesFilling (Restoration)Gum Treatment (Periodontics)ImplantInvisalign ConsultationNormal ExtractionRoot Canal TreatmentScaling & PolishingVeneer ConsultationWisdom tooth ExtractionOthers

Any Preferred Dentist?* (Please note that dentist availability is also subject to clinic location.)
NoYes (Please specify in Remarks below)

Remarks

Please be aware that your appointment is NOT CONFIRMED until we have contacted you. If you require an urgent appointment, please call our clinics directly.

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