denticare form

Name: Invisible Orthodontics
Address: Hervey Bay 1/10 Pier St, Urangan, Queensland, Australia
Telephone: (07) 5437 8080

For further information about how we use your data, please see our privacy policy

Responsible party for payments

A Responsible party must be an Australian citizen, employed, 18 years of age or older and not subject to bankruptcy or any debt agreements.

Title

First Name

Last Name

DOB

Mobile Phone Number

The Payment Plan

Total Treatment Fee ($)

Deposit Paid to Practice ($)

Payment Plan Amount ($)

Number of Debits

Direct Debit Amount ($)

The first Debit Amount will be debited on the

followed by the Direct Debit Amount above each

Please select frequency Week Fortnight Month

A one off $49 set up fee will be charged with the first payment.

I, the Responsible Party as detailed above, agree to the Payment Plan as set forth in above section.

Please sign:

By clicking submit, you are agreeing to our privacy policy.

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ready to start
your smile journey?

It’s easy to get started with Invisible Orthodontics!
Reserve your consultation by making a single payment of just $59 (children) or $225 (adults).
If you decide to move forward, we’ll apply that amount to the cost of your treatment.

Book your orthodontic consultation

our locations come and
visit us

We have three convenient coastal locations, come and meet us in your preferred practice!

Hervey Bay Sunshine Coast

Hervey Bay practice

address

1/10 Pier St, Urangan, QLD, 4655

telephone

(07) 5437 8080

opening times

Tue 8:30am - 5:00pm

back book now

Sunshine Coast practice