BOOK A DENTIST AND ORAL HYGIENIST APPOINTMENT

Complete the form and we will do our best to arrange an appointment with a Cape Town based dentist and/or oral hygienist based on your preferences below.

Your First Name
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Field is required!
Your Last Name
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Field is required!
Your E-mail Address
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Field is required!
Your Phonenumber
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Field is required!
Type of Booking
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Field is required!
Choose your Preferred Dentist
  • - select a option -
  • Dr. Theo Van Der Walt
  • Dr. Pieter van Rooyen
  • Dr. Andrew Ellis
  • Dr. Thomas Klein
- select a option -
Field is required!
Field is required!
Preferred Booking Date
What is the earliest date you would like us to book an appointment for you.
Select a earliest date you would like to be seen.
Field is required!
Field is required!
Alternative Booking Dates
What is the latest date we can book an appointment for you (max. 7 days after preferred date)
Select a latest date you would like to be seen.
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Field is required!
Brief description of the nature of your appoint. Max120 characters.
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Field is required!

Book Your Oral Hygienist

Choose your Preferred Oral Hygienist
Choose "No One in Particular" if you have no preference.
  • - select a option -
  • Cenobia De Jager
  • Jackie Goldberg
  • Chrismarie Barnardt
  • Anne-mari Gericke
  • No One in Particular
- select a option -
Field is required!
Field is required!
What time would you like to see the Oral Hygienist?
Please note, you can only book on the hour.
What time would you like to see the Oral Hygienist?
Field is required!
Field is required!

Book Your Aesthetic Injetor

Choose your Preferred Aesthetic Injector
  • - select a option -
  • Dr. Fenton
- select a option -
Field is required!
Field is required!
What day would you like to see the Aesthetic Injector?
What day would you like to see the Aesthetic Injector?
Field is required!
Field is required!
What time would you like to see the Aesthetic Injector?
What time would you like to see the Aesthetic Injector?
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Version 3.2
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