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Pre-Consultation
 Photos

In advance of your upcoming consultation with Dr. Joseph O’Connor, we kindly request that you provide a set of photos to help us prepare for your visit.

These photos will be reviewed by our orthodontist prior to your appointment, allowing us to plan and tailor your consultation more effectively.

Please follow the steps on the form below to submit your photos. Thank you.

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Personal Details

First Name
*
Surname
*
Date of Birth
*
Phone Number
*
Email
*
Address
*
Town
*
County
*
Eircode
*

Treatment Costs

Total Cost of Treatment (€)
*
Deposit Amount (€)
*

Recurring Payments

Number of Payments
*
Amount
Recurring Amount (€)
Recurs Every (Days)
*
Success

Your online payment details have been received. A member of our team will confirm that the details and amounts are correct.

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Patient Details

First Name*
Surname*
Is this consultation for your child?*
Child's Name*
Date of Birth*
Phone Number*
Email*

Consultation Details

Which teeth would you like to fix?
What are your main concerns with your smile?
Are there any particular treatments you are interested in?
Do you know when you would like to begin treatment?

Images

Please upload 5 photos as shown in the images below. These will enable your orthodontist to assess your smile & advise on the best course of treatment.
Upload Image 1*
Upload Image 2*
Upload Image 3*
Upload Image 4*
Upload Image 5*
Is there anything you feel we didn’t ask you?
By submitting this form, you consent to being contacted (Privacy Policy).
Success

Your details have been sent. We will be in touch to arrange a date and time.

If you need to contact us urgently, please call (01) 4920 622.

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In-Person
Online

Patient Details

First Name
*
Surname
*
Phone Number
*
Email
*
Message (optional)
By submitting this form, you consent to being contacted (Privacy Policy).
Success

Your details have been sent. We will be in touch to arrange a date and time.

If you need to contact us urgently, please call (01) 4920 622.

Something went wrong while submitting the form. Please try again or refresh the page and try again.