NHS
NHS
Colchester Town Centre Practice
39 Saint Botolph's Street, Colchester, CO2 7EA
Mile End Practice
61 Mill Road, Colchester, Essex, CO4 5LE

Online Smile Questionnaire

In preparation for your video appointment with Dr Prashar or one of our dentists, please let us know a little more about your smile, by completing the form below. It will only take about 2 mintues and is easy to complete, but any problems, please get in touch with our friendly team by calling 01206 767471.

 

ONLINE SMILE ASSESSMENT
Please ensure you complete all of the required fields on the referral form and then click send.
 
Smile Assessment Form
Please upload some photographs of your teeth to help our dentists assess your smile & advise on the best course of treatment.

Please note, below you can upload as many as five different photos. Take a look at the examples below for the most useful images. This is optional but would be most helpful.

Example Smile Upload Photos


Please understand that by submitting this form, you consent to future contact from The Smile Clinic by phone and or email. We will never sell your personal data under any circumstances & you may opt-out of receiving our communications at any time.

 
 
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Company registration number: 05535929, UTR: 1512412238, UK registered address: Beaumont Seymour, 47 Butt Road, CO3 3BZ