Eastern Blades Mouthguards – Surgery Booking

PLEASE NOTE – This is a booking for our Subiaco Surgery
324 Churchill Ave, Subiaco WA 6008

On this page you can book an appointment for our GAP FREE custom mouth guard offer with impressions to be taken at the club on your selected day.

Our GAP Free custom mouth guards are configurable in one, two or three colour options with a wide selection of colours available. You may also choose to select to decide colours at your appointment, this option is in the colour choices drop down.

Please note: there are configuration options and extras that may add some cost to the gap free offer, whilst the base mouth guard will be gap free these small charges would be added on and required to be paid at the time of booking this appointment. (One example of this option would be embedding the wearer name into the mouth guard)

Name of the Mouthguard wearer*
Private Health Insurance
Private Health Insurance*
Is this person covered by Private Health Insurance
- Yes
- No
Health Fund*
As you have indicated you do not have Private Health Insurance we can not provide our GAP Free offer to you. We can still produce you a premium quality custom mouthguard, however this will cost $150 for the base product. If you require additional information please click here.
Colour Choices
Mouthguard Colours*
Please select mouthguard colours. Please note, you can leave this blank and select the impression appointment.
Click here to view our colour chart.
Color 1
Color 2
Color 3
Additional Items
Wearer D.O.B.*
Please enter the wearers date of birth.
Date Format: DD slash MM slash YYYY
Single or Dual Layer?*
A dual layer mouthguard is highly recommended for 12+ year olds playing AFL or Rugby, and for athletes in high contact sports incl. boxing, hockey, karate, waterpolo etc
- Single Layer
- Dual Layer
Name on mouthguard.*
You can select to add the Name & a mobile number on the inside of the mouthguard.
- No name on mouthguard
- Add wearers name and number to the mouthguard
Name on mouthguard
You have chosen the option to add the wearer name and number to the mouthguard. Please enter the information EXACTLY as you would like it to be shown.
Delivery or Pickup?
We can have your mouthguard delivered (posted) out to you once it is complete, alternatively we do offer pickup from our Subiaco dental surgery (address below). Please select your option.
Delivery Choice*
- Post
- Subiaco surgery pick up
- Club Drop Off
Allergies
Any Allergies (e.g. Latex) or medical conditions the Dentist should know about?
Summary
Your base mouthguard is GAP Free. If you have added any options (or do not have Private Health Insurance), this is the total of the add on costs payable at time of booking.
Product Name
Total
$ 0.00

Subtotal
Options
Total

Category: Uncategorized

Eastern Blades Mouthguards – Surgery Booking

Private Health Insurance

Colour Choices

Additional Items

Delivery or Pickup?

Allergies

Summary

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Eastern Blades Mouthguards – Surgery Booking

Private Health Insurance

Colour Choices

Additional Items

Delivery or Pickup?

Allergies

Summary

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