How old are you? *

Under 18

18-29

30-45

Over 45

How concerned are you about the appearance of your dental treatment? *

Not concerned at all

Slightly concerned

Neutral

Somewhat concerned

Very concerned

Are you willing to wear orthodontic appliances 24/7? *

Yes. I’m okay with wearing them 24/7

No. I prefer a more flexible, removable option

Can you commit to dietary restrictions? *

Yes

Some orthodontic treatments require you to avoid specific types of food.

Do you participate in any activities or sports that might involve impacts to your face? *

Yes, regularly

Occasionally

No, not at all

How disciplined are you with following strict guidelines or routines? *

Not disciplined at all

Somewhat disciplined

Neutral

Fairly disciplined

Very disciplined

Are you okay with having more frequent in-office visits for adjustments? *

No, I prefer fewer visits

Yes, I’m okay with frequent visits

Do you have any metal allergies or sensitivities? *

Yes

I'm not sure

What is your budget for orthodontic treatment? *

RM7,500 - RM10,000

RM10,000 - RM15,000

RM15,000+

I'm open to flexible payment options

All treatments have 0% instalment plans.

Do you currently have any dental appliances or previous orthodontic treatment? *

Yes, I had orthodontic treatment in the past

Yes, I currently have dental appliances

No, I have not had any treatment

How long are you willing to undergo treatment? *

Less than 12 months

18-24 months, As long as it takes

12-18 months

Full Name *

Phone *

Email *

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