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Why are you seeking Orthodontic Treatment?
Why are you seeking Orthodontic Treatment?
I want to straighten my teeth
I want to correct my bite
I have a tooth that is stuck
I have jaw pain
I was referred by my Dentist
What is the name of your Dentist/Dental Practice?
What is the name of your Dentist/Dental Practice?
What location are you interested in coming to?
What location are you interested in coming to?
-- Please select an option --
Lloydminster
Cold Lake
Camrose
Do we have permission to request x-rays from your dentist?
Do we have permission to request x-rays from your dentist?
Yes
No
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