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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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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.
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Athlete's First Name (child)
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Athlete's Surname
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Parent/Guardian Full Name
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Address
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Phone number
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Inspirations
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Single colour (included in the price) Please add colour choice in next sections comments
2 Colours (included in the price) Please add colour choice in next sections comments
Special Stripe + $10 Please add colour choice in next sections comments
Harlequin + $10 Please add colour choice in next sections comments
Marble + $10 Please add colour choice in next sections comments
Tiger/Zebra + $10 Please add colour choice in next sections comments
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).
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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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