|
International office for  Australia and  New Zealand: Miss Meng Amanda
Georges Terrace Perth, WA, 6000, Australia
|
| Please
Fill in Your Info |
| |
Mr.
Mrs.
Miss. |
| First Name : * |
|
| Last Name : * |
|
| Age : |
|
| E-mail 1 : * |
|
| E-mail 2 : |
|
| Country : |
|
| Phone
: * |
|
| Appointment
Date |
| Date: |
DD-MM-YYYY |
Time
|
| If
you are tourist, what hotel you’ll stay in Bangkok?
|
| Hotel
/ Guest House
/ Apartment |
| |
|
| Have
you ever visit us before? |
| |
Yes
No |
| Your
Requirement |
| |
Make an Appointment
Ask for a Quotation
Make a Consultation online |
| |
Special Dental Package
Treatement
Treatement + Hotel |
| Treatment
(You can choose more than one) |
| |
|
| |
|
| If you want
to send our dental specialists your x-rays , pictures
or dental records, please send directly to our email
below: |
| :: dentist@thaidentalcenter.com |
| |
| More
details |
|
I want to know more about the dental guarantee for oversea clients |
|
|
|
In
case of temporarily down , please use the other registration
form at
http://www.thaidentalcenter.com/contact.html |
Copyright © by Thailanddentalcenter.com