Answer a few questions & upload a selfie to get some free advice.
1. What is your Name?
*
2. What is your email address?
*
We take privacy very important and I won't share this or spam you.
3. What is your mobile number ?
*
Clearcorrect - When was your last dental checkup?*
Last dental checkup
Within the last year
1-5 years ago
5+ years ago
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Clearcorrect - Which teeth do you want to fix? *
Upper teeth
Lower teeth
Upper & lover teeth
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Clearcorrect - What are your main concerns?
Choose as many as you like
A : Gaps in my teeth
B : Crooked teeth
C : Sticking out teeth
D : Worn & chipped teeth
E : Discoloured teeth
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Clearcorrect - How important is it to fix your smile this year?*
1 (not at all) - 10 (very)
1
2
3
4
5
6
7
8
9
10
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Clearcorrect - Would you like to upload a quick photo (selfie) of your smile?*
This will help to provide you with detailed advice & recommendations.
Yes
No
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Clearcorrect - Upload up a photo of your smile, showing your teeth, so that we can assess and give you some advice.
Note this is optional (and you can skip) but it does help us give you more detailed advice.
Clearcorrect - Did we forget something?
Clearcorrect - I want to start treatment:*
A : Right now
B : Within 30 days
C : In about 6 months
D : Not sure, I just want more info
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Clearcorrect - I would like to arrange an appointment*
A : Yes
B : No
C : Maybe later
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