• 237 Greenhill Road, Dulwich
  • 08 8431 6162
Step 1. Photos saved on your phone/computer

Before beginning this form, please take photographs on your mobile phone.
(Optional, but preferred method of assessment)

  1. Patient’s upper right back teeth
  2. Patient’s upper left back teeth
  3. Patient’s lower left back teeth
  4. Patient’s lower right back teeth
  5. Front teeth with lip lifted

PLEASE NOTE: After completing and submitting this form please call 08 84316162 to arrange a 30 minute Teleconsultation with you and your child. Please be advised a fee of $55 may apply, private health insurance rebates may not be applicable at this time.

Step 2.