Shield Mouthguards
Private health funds may offer a rebate. If you would like to check the item numbers are  014 & 151 and you can use the provider Number 4114051F. The total cost is $155.00

Please add the email where you would like your invoice sent to.

If you have more than one child to order for, please fill out a new form for each child. after submitting the first child it will give you the option for a new submission for the 2nd child.
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Email *
Does your child have braces or fixed orthodontic appliances? If yes, Unfortunately these athlete's can't be seen on a  school visit. We are happy to look and advise on suitability, but all appointments would need to take place in the clinic.
Athlete's First Name (child) *
Athlete's Surname *
Parent/Guardian Full Name *
Address *
Phone number *
Inspirations
Captionless Image
Some examples (not limited to, simply some to visualise) all these are +$10
Colour choice (can be left empty, and chosen on the fitting day, we will have some more examples to see).
Do you have any Comments to add? If there are any further questions I can answer, please fell free to contact me on 9560 7885                                                                                               or michael@denturesbymichael.com.au                         99 Marion st Leichhardt
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