How many missing/broken teeth do you have? *

All

6+

3-5

2 or Less

How would you like to fund your treatment? *

Payment plan

Accessing my Super (If eligible)

I'd like to use my savings

Access to Super only available under strict eligibility criteria

Are you an Australian Permanent Resident? *

Yes

No

What is your current employment status? *

Working Full Time

Working More than 20hrs/week

Working Less than 20hrs/week

I am not working

Unfortunately, it looks like qualifying for a payment plan would be difficult. Do you have any other way to pay for your procedure? *

Superannuation Funds

Savings

Credit Card

Help from a relative

No, I don’t

Please confirm which best describes you *

I have $50k+ in my Super

I have $30k-$50k in my Super

I have $10k-$30k in my Super

I have less than $10k in my Super

Access to Super only available under strict eligibility criteria

Please confirm which best describes you: *

I have $50k+ in Savings

I have $30k-$50k in Savings

I have $10k-$30k in Savings

I have less than $10k in Savings

Please confirm which best describes you: *

I have $50k+ in Credit available

I have $30k-$50k in Credit available

I have $10k-$30k in Credit available

I have less than $10k in Credit available

We’ll call to discuss your treatment options and assess your eligibility, you can then book a free ($1,000 value) consultation with our expert dentists. If you proceed with booking an appointment, a small refundable deposit may be required to confirm your attendance. *

Yes!

Which state do you currently live in? *

New South Wales (NSW)

Victoria (VIC)

Queensland (QLD)

South Australia (SA)

Western Australia (WA)

Northern Territory (NT)

What is your First Name *

What is your Last Name *

What is your Email Address? *

What is your Phone Number? *

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