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Mr.
Mrs.
Miss. |
| First Name : * |
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| Last Name : * |
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| Age : |
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| E-mail 1 : * |
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| E-mail 2 : |
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| Country : |
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| Phone
: |
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| Appointment
Date |
| Date: |
DD-MM-YYYY |
Time
|
| If
you are tourist, what hotel you’ll stay in Bangkok?
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| Hotel
/ Guest House
/ Apartment |
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| Have
you ever visit us before? |
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Yes
No |
| Which
branch you are interested to visit us? |
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Ploenchit branch
Sukhumvit 21 branch
Sukhumvit 63 branch |
| Your
Requirement |
| |
Make an Appointment
Ask for a Quotation
Make a Consultation online |
| |
Special Dental Package
Treatement
Treatement + Hotel
Treatement + Vacation Package
Treatement + Hotel + Vacation Package |
| Treatment
(You can choose more than one) |
| |
|
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| If you want
to send our dental specialists your x-rays , pictures
or dental records, please send directly to our email
below: |
| :: contact@bangkoksmiledental.com |
| |
| More
details |
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Incase
of Emergency contact Mr. Sukit (Oat) at
Mobile: + (66) 8 4141
0388
Tel: + (66) 2664 2929
Fax: + (66) 2664 2900
MSN Messenger : thailanddentalcenter@msn.com
Skype ID : thailanddentalcenter
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that you will receive our email, please add
our following email address , contact@bangkoksmiledental.com
into your address book.
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