Free on line diagnostic evaluation


	Name* :
	Surname* :
	City :
	Country :
	E-M@il* :
	Telephone number* :
	Short dental problem description*

	To obtain a personalised consultancy it is indispensable to send an Orthopantomography (Panoramic X-ray) in electronic format by this form or by post to: Excellence Dental Network - via dell'Ariento, 4 - 50123 Firenze.

	We will contact you by phone after examining the X-ray. It is necessary to point out that the advice provided is to be understood as suggestions given for guidance and cannot be considered as substituting the medical examination. The phone consultancy will concern exclusively medical questions and economic evaluations will not be provided. Privacy italian law: D. LGS 196/2003. I authorize PESS SRL (owner of EDN brand) to processing my personal data.
	* Mandatory Data