#03-04 Civic Centre
6363 3350
#02-12/13/14 City Gate
6974 1800
* Required fields
Preferred Date
Date of Birth
Preferred Date Preferred TimeMorningAfternoonNight
Preferred Day of weekMondayTuesdayWednesdayThursdayFridaySaturday
Preferred BranchWoodlands - Woodlands Civic CentreBeach Road - City Gate Shoppes & Residences
Preferred DentistAny DentistDr JonPaul SeahDr Gina HauDr Chua Yih JiaDr Brina HoDr Andre LioeDr Jayden WongDr Julia ChewMs Norah Sarmani (OHT)Ms Amedah Soh (OHT)Dr Sharon Loh (Braces only)
First Time patientYesNo
SubjectComplaintEnquiryFeedbackSuggestion
ENQUIRY