We invite you to complete the form below to receive a detailed FirmQuote™ for your particular dental procedure(s), packages, or treatments. Simply select your preferred destination, dental clinic, or dentists (if known), and we will obtain your personal feedback with a confirmed firm price. Dental feedback can take up to 5 business days.

Dental Form

  • Contact Information

  • Travel Companion Details

  • Emergency Contact Details

  • Dental Procedures/Treatments

  • Preferred Destination
  • Dentistry Treatments
  • Dates

  • Family Medical Conditions

  • Patient Medical Conditions

  • Habits

  • Women

    Accurate and clear photographs are a valuable tool for your dentist to conduct a virtual consultation of the areas of your mouth that you would like to address. Once reviewed by the dentist with feedback and  recommendations we can prepare a FirmQuote™ and begin to plan your dental holiday. 

    Taking photos of your teeth and forwarding them to us for the dentist to comment is required. This will help to provide a better recommendation on what dental procedures would be best for you. We appreciate that getting clear pictures is not easy, but having a front view, with your lips retracted by your fingers and a top and bottom photo will assist.

    When taking photos please consider the following:

    1. The photographs should clearly show your teeth as per the photographs below.
    2. Photographs should be recent and certainly not more than 6 month old.
    3. Photographs should be clear, and in focus. 
    4. Photographs should not be less than 200kb.

    In addition to your photos we will require a recent panoramic x-ray or Dental Ct-scan (for dental implants) and not more than 6 months old. This can be obtained from your local dentist, referred to a local xray facility by a local dentist, or available without a referral at some local private exam facilities in your area. 

  • Drop files here or
    Accepted file types: jpg, gif, png, pdf, doc, zip.
    • Have you included photos, x-ray (within 6 months) and/or any current dental plans?