EmailMeForm
Fill in your details below and we will contact you to make an appointment for your child.
Please note: A ‘No Caller ID’ will appear when the clinic phones you.
Parent/Caregiver name
*
First
Last
Preferred phone number
*
Confirm phone number
Suburb/Location of Dental Clinic
*
Please select
Angle Park (Parks)
Berri
Birken Head (Le Fevre)
Bordertown
Clare
Elizabeth
Evanston
Henley Beach (Fullham Gardens)
Kangaroo Island (Private practice contracted for children services)
Kingston (Private practice contracted for children services)
Kingswood (Mitcham)
Magill
Maitland
Marleston
Millicent
Modbury
Mount Barker
Mount Gambier
Murray Bridge
Naracoorte
Noarlunga
Oaklands Park (Marion)
Pennington
Peterborough (Private practice contracted for children services)
Port Augusta
Port Lincoln
Port Pirie West
Prospect
Royal Park (Hendon)
Salisbury
St Georges (Linden Park)
Streaky Bay (Private practice contracted for children services)
Victor Harbor (Private practice contracted for children services)
Wallaroo
Whyalla
Preferred time to call
(we will endeavour to contact you at the specified time)
9:00am to 12:00pm
12:00pm to 4:00pm
How did you hear about us?
*
Please select
Facebook
School
Website
Word of mouth
Other
