Let's Get Started
Please fill in this short questionnaire to get started!
How can we help your child?
Treat alignment issues
Alright! Let’s see how we can help. What alignment issues are you trying to address? (select any that applies)
Where are you in your research on getting braces?
I’ve just started my research
I want to speak with a specialist on options and cost for braces
I’m not sure what is best for my situation!
Our orthodontist can definitely help. Would you like your consultation at the clinic, or through a video conference call?
At the Vancouver clinic - 182 East 15th Ave
At the Surrey clinic - 7388-137th Street, Suite 3
Virtual appointment by video conference call
How did you hear about PacificWest?
Word of mouth / friend / family
Your Contact Info
Alright! We’re all set. Please leave your contact information below. We will send you more information and contact you to set up a free consultation to find the best treatment option for you.
Please enter a valid phone number.
Preferred day / time of appointment
Name of dentist who referred you
Any notes or comments for us
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