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Please complete the following form to request an appointment to see Dr Tiang.  Questions with a * next to them are compulsory.
By indicating your preferred day and time we will contact you back and do our best to accommodate you in our schedule as soon as possible.


Please note that this form should not be used in case you are seeking urgent emergency dental treatment.  If you have an urgent dental
problem then please contact your own dentist. For existing patients of Dr Tiang, please call his office directly or if it is after hours, call the
emergency number as can be found on his business card.

First Name  *
Last Name 
Contact telephone number  *
Email Address  *
Preferred day of the week to be seen 
Preferred time of the day for appointment 
Dental practice you would like to be seen at  *
What is the purpose of your appointment? 
Consultation regarding the options for straightening my teeth
Consultation regarding Invisalign
Consultation regarding what cosmetic dentistry can do for my smile
Consultation regarding whitening my teeth
General checkup for my teeth
Other reason - please put details in the Comments box below

Tick if you would like an indication of the costs involved 
Additional comments 
Where did you first hear about us?