Step
1
of
3
33%
Name
(Required)
Age
(Required)
Gender
(Required)
Phone
(Required)
Email
(Required)
City
(Required)
Please select your city
Ahmedabad
Bangalore
Mumbai
Pune
Surat
Vadodara
Others
Why do you want to get Ortho/Clear Aligners Treatment?
(Required)
Crooked Teeth
Protruding Teeth
Gaps in Teeth
Other
Have you ever visited a dentist for a consult for Ortho/Clear Aligners treatment?
(Required)
Yes
No
Third Choice
When was the last time you visited a dentist?
(Required)
Less than a year
1-5 Years
More than 5 years
Are you aware that Ortho/Clear Aligners treatment lasts for 12-24 months?
(Required)
Yes
No
Are you aware that the cost of Ortho/Clear Aligners treatment starts from Rs.25,000/-?
(Required)
Yes
No
Do you have an OPG / Full Mouth X-Ray with you?
(Required)
Yes
No
How soon are you planning to start the treatment?
(Required)
Immediately/ASAP
In one month
In 3 months
Not sure
When can you come for a checkup with our Orthodontist (Dentist with specialisation in Ortho/Clear Aligners)?
Yes
No
Would like to talk to a dentist right away?
Yes
No
Would you like to book an appointment at a Sabka Dentist Clinic?
(Required)
Yes
No
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Treatment Prices
