E-Consultation

To book your appointment, complete the form below:

After your case has been submitted and evaluated by Dr. Azzawi, your consultation will include:

  • Video call with Dr.Azzawi.
  • A report explaining the cause of your dental problem.
  • Treatment plan.
  • Estimated cost of the treatment required.
  • Estimated duration of the treatment required.

If you wish to proceed with our online consultation:

  • You must upload clear photos of your teeth and your Panoramic X-ray as shown in the template above.
  • After having your form filled and approved, you will receive the payment link on your email.
  • Once the payment is successfully done, we will call you to schedule your consultation appointment.
  • Kindly note that there will be no treatments done nor medications prescribed during the online consultation.
  • Terms and conditions apply.

    Full Name
    Gender
    MaleFemale
    Date of Birth

    Your Email

    Contact Number

    Your Message

    Front teeth picture*

    Side teeth picture*

    Upper teeth picture*

    Lower teeth picture*

    X-Ray picture if available

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