The CEREC Centre, Riccarton Dentists, Christchurch, New Zealand

Enquiry Form / Is CEREC right for me?


Title: I am an existing patient:
Yes: No:
Firstname: I last visited the dentist:
Surname: I am concerned about:
Chipped/Broken Teeth
Old caps or crowns
Ugly metal fillings
Other
Email address:
Please tick this box if you are happy for us to contact you by email:
Telephone:
Do you have a promotional code?
If so, please enter here:
I am currently experiencing tooth pain:
Yes: No:
Address :    
What brought you to the web site?
I am a patient and I received a postcard.
I am a patient and Wayne told me about the site.
I am not a patient but a friend or family member is and they told me about the site.
I am not a patient, I was referred by another dentist.
I am a dental colleague of Wayne's.
Magazine Advertisement
Other, please state:

Thank you for completing the questionnaire, I will get back to you.

Kind Regards,


     Wayne Moyle

 

“Unquestionably the most cost-effective, durable and aesthetic restoration available”


Dr Wayne Moyle, Riccarton Dentists,
e. info@riccartondentists.co.nz p. 03 343 3747
111 Matipo Street, Riccarton, Christchurch

 
 Copyright © 2006 Riccarton Dentists