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Форма онлайн записи
data and problem

Book an Appointment

Step 1: Your details, concerns and requirements
All fields are required
Your data
Your first and last name
E-mail
Phone
Patient's age
Your concerns:
Necessary treatment
What are the three points of treatment that are most important to you
Which brace system are you interested in?
Write if you know
When would you like to start treatment?
Write if you know
Describe your situation or ask any questions that interest you
Optional
Step 2: Upload photos
All fields are required
We recommend taking photos in front of a mirror in good lighting with a flash or ask your friends or family to help you. The most convenient and fastest option is taking pictures on your smartphone, you will be able to fill out the form from your phone and upload the pictures you took. After uploading your photo, the picture in the form will not change, but will be marked with a check mark - this means that the upload was successful.
Maximum file size - 10MB
Face in full-face
Face in profile
Smile
Loose teeth
Clenched teeth
Upper dentition
Lower dentition
Profile left, teeth clenched
Right profile, teeth clenched

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