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Do you require dental treatment
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Participate in our survey and we'll assist you for your dental care needs
*
Indicates required field
Do you presently have a dentist that you visit on a regular basis?
*
yes
no
The most common reason for not going to the dentist is:
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I do go for regular check-ups
The cost of care
I don't like dentists
There is nothing wrong with my teeth
Other
Do you have pain in your teeth
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never
mild and occasionally
sever and occasionally
continous
Are your teeth stained
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yes
no
Your name, mobile number and E-Mail ID
*
Submit