Patient Name * First Name Last Name Patient Email Please provide patient email for us to email the quote. Please leave blank if you would like us not to email the patient the quote. Dental Clinic Performing Sedation * Please Provide the Name of the Dental Clinic providing the Dental Treatment Dental Clinic Email Please provide dental clinic email so that we can email you a copy of the quote. Please provide the number of hours you want your sedation for. Please enter 1 and a half hours as 1.5 Thank you!A quote has been emailed to the nominated email address. Please contact us if you have any trouble!
