Let's Get Started
Please fill in this short questionnaire to get started!
Yes. I want to speak with a specialist
I am unsure; want to ask questions
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 Invisalign
I’m not sure what is best for my situation!
Are you aware of other “invisible” braces options, such as lingual braces?
Yes I am aware, but I think Invisalign is best for me
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
Last question - how did you hear about PacificWest?
Word of mouth / friend / family
Parent inquiring for my child
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 with one of our specialists 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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