1300 NIP TUK Contact Us

Free Dental Assessment

Please complete the NipTuck Dental Form and submit the required photos. This will allow us to ensure the right NipTuck Team of Dentists to assess your individual needs and provide the recommended recommendations and pricing.

Patient Information

Please complete this form truthfully. A false declaration may result in rejection of treatment. All information is strictly confidential.

GenderRequired

Please enter height in cm (e.g. 162) and weight in kg (e.g. 68). Both are required to calculate BMI for assessment.

Medical History

Heart Disease
Diabetes
Hypertension
Bleeding Tendency
Asthma
HIV
Cancer
Other

Dental History

Do you have existing dental implants?
Do you grind your teeth (bruxism)?
Do you have gum disease or bleeding gums?
Do you experience tooth sensitivity?
Do you know what dental procedures you need?

OPG X-Ray

We require an OPG (Orthopantomogram) X-ray for dental assessment. See example below.

Example: an OPG dental X-ray, the whole jaw in one panoramic image
Example OPG X-ray
Have you had an OPG dental X-ray in the last 6 months?

If yes, please email a digital copy to: info@niptuckholidays.com

If you only have a hard copy, please ask your dentist or X-ray clinic for a digital copy and email it to us.

Dental Photos Required

At NipTuck Holidays, we understand the importance of maintaining your privacy and appreciate your trust. Just like any other personal medical information we need to collect, your private photos remain confidential and are handled with the utmost respect and care.

  • If possible, have someone else take your photos.
  • Make sure your photos are clear and in focus.
  • Take your photos in good, even lighting.
  • Follow the example images for the correct positions and angles as best as you can

Please provide clear photos similar to the examples below to info@niptuckholidays.com

Example: Front Smile View — Natural smile, full face
Front Smile ViewNatural smile, full face
Example: Upper & Lower Arch — Looking into open mouth
Upper & Lower ArchLooking into open mouth
Example: Cross Bite / Side View — Teeth together, side profile
Cross Bite / Side ViewTeeth together, side profile

Desired Treatment

Desired Treatment

Acknowledgement

Your answers

I confirm the information provided is accurate to the best of my knowledge. I understand that providing incorrect information may affect my treatment and incur additional costs. It is my responsibility to inform NipTuck Holidays and my treating dentist of any changes to my health status.

Typing your name counts as the signature.

In facilitating medical tourism services, we collect sensitive personal and health information (including medical histories, diagnostic files, and treatment requirements). To coordinate your care, we disclose this information to third-party medical providers, hospitals, clinics, and surgeons located outside of Australia. Destinations where recipient health providers are located include, but are not limited to: Thailand, Turkey, South Korea, Vietnam, Indonesia (Bali), and Mexico.