Enter Your Details Below
Then click the 'Next' button at the bottom of this form
First Name
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Last Name
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Email
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Cell Phone Number (No Landlines)
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Our dentists are located in Brisbane. Does this work for you?
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Yes, going to see the dentist in Brisbane is all good for me
No, it does not work for me
Great! As requested, we’ll soon give you a call to discuss the process of gaining early access to your super for dental treatment - all you need to do is reply to the text we’ll send after you submit this form. This is a no-obligation call - you will be given all the information and if you’d like to book a consultation you will be offered a $75 prepaid appointment (valued at $350) with the dentist.
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Yes, I understand and would like a phone call to learn more. I will reply to the SMS text that you will send me now.
No, I’m not interested.