Dr Sahanai Paediatric Dentist
Parent/Guardian Name
Phone Number
Child’s Name
Child’s Age
Reason for Visit First Dental Visit (New Patient)Routine Check-up & CleaningTooth Pain / EmergencyMyobrace / Orthodontics ConsultationTongue-Tie / Laser AssessmentZirconia Crowns / RestorationOther
Preferred Date/Time
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