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Dental Evaluation Form

Please complete this confidential form for your FREE Dental Assessment from one of our DDS Clinic Dentists.

Please note that a confirmed treatment plan can only be provided when you are examined by the Dentist. All quotations provided are estimated costs of the procedure requested. All estimates given are subject to change.

Please don’t forget to email us your photos after you complete the evaluation form below. Please email photos to: enquiries@medimakeovers.com

Assessment details

Please don’t forget to email us your photos after you complete the evaluation form below. Please email photos to: enquiries@medimakeovers.com

Below pictures are the photo samples in 5 different views.

You can simply take the photos by yourself or with a little help from a family member, just make sure that you completely bite with your back teeth when shooting.