Please make sure that all details are correct before you submit the questionnaire. PLEASE NOTE: Your mobile number must be valid in order to receive the prescription token ID code via Clynxx. Please proceed with a prescription request for medication only if it is genuinely required. We occasionally have patients complete the questionnaire and contact our dentists via WhatsApp, but then abandon the prescription process. This takes clinical time that could otherwise be allocated to patients who genuinely require our service. If you do not require a prescription or do not intend to proceed with the consultation, please do not submit a request. If you genuinely require a prescription for medication, please continue below.