{"id":1001,"date":"2026-05-08T06:23:36","date_gmt":"2026-05-08T06:23:36","guid":{"rendered":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/?page_id=1001"},"modified":"2026-05-11T15:37:16","modified_gmt":"2026-05-11T15:37:16","slug":"dentist-referral","status":"publish","type":"page","link":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/dentist-referral\/","title":{"rendered":"Dentist Referral"},"content":{"rendered":"<section class=\"bde-section-1001-100 bde-section\">\n  \n  \n\t\n\n\n\n<div class=\"section-container\"><div class=\"bde-columns-1001-101 bde-columns\"><div class=\"bde-column-1001-102 bde-column\">\n  \n  \n\t\n\n\n\n<img decoding=\"async\" class=\"bde-image2-1001-103 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/04\/logo.png\" alt=\"logo\" loading=\"lazy\" sizes=\"(max-width: 224px) 100vw, 224px\">\n<\/div><div class=\"bde-column-1001-104 bde-column\">\n  \n  \n\t\n\n\n\n<div class=\"bde-wp-menu-1001-105 bde-wp-menu\">\n\n\n      \n        \n    <nav class=\"breakdance-menu breakdance-menu--collapse    \">\n    <button class=\"breakdance-menu-toggle breakdance-menu-toggle--squeeze\" type=\"button\" aria-label=\"Open Menu\" aria-expanded=\"false\" aria-controls=\"menu-105\">\n                  <span class=\"breakdance-menu-toggle-icon\">\n            <span class=\"breakdance-menu-toggle-lines\"><\/span>\n          <\/span>\n            <\/button>\n    \n  <ul class=\"breakdance-menu-list\" id=\"menu-105\">\n              \n  \n    <li id=\"menu-item-18\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-home menu-item-18 breakdance-menu-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/\" class=\"breakdance-menu-link\">Home<\/a><\/li>\n<li id=\"menu-item-620\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-620 breakdance-menu-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/booking\/\" class=\"breakdance-menu-link\">Booking<\/a><\/li>\n<li id=\"menu-item-649\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-649 breakdance-menu-item breakdance-dropdown breakdance-dropdown--wp breakdance-dropdown--with-link\"><div class=\"breakdance-dropdown-toggle\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/treatments\/\" class=\"breakdance-menu-link\" aria-expanded=\"false\">Treatments<\/a><button class=\"breakdance-menu-link-arrow\" type=\"button\" aria-expanded=\"false\" aria-label=\"Treatments Submenu\"><\/button><\/div><div class=\"breakdance-dropdown-floater\" aria-hidden=\"true\">\n  <div class=\"breakdance-dropdown-body\">\n    <div class=\"breakdance-dropdown-section\">\n<ul class=\"breakdance-dropdown-links\">\n\t<li id=\"menu-item-664\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-664 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/invisalign-for-adults\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Invisalign For Adults<\/span><\/a><\/li>\n\t<li id=\"menu-item-702\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-702 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/invisalign-for-teens\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Invisalign For Teens<\/span><\/a><\/li>\n\t<li id=\"menu-item-724\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-724 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/invisalign-first\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Invisalign First<\/span><\/a><\/li>\n\t<li id=\"menu-item-751\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-751 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/braces-for-adults\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Braces For Adults<\/span><\/a><\/li>\n\t<li id=\"menu-item-778\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-778 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/braces-for-children-and-teens\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Braces For Children and Teens<\/span><\/a><\/li>\n<\/ul>\n    <\/div>\n  <\/div>\n<\/div><\/li>\n<li id=\"menu-item-635\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-635 breakdance-menu-item breakdance-dropdown breakdance-dropdown--wp breakdance-dropdown--with-link\"><div class=\"breakdance-dropdown-toggle\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/about-us\/\" class=\"breakdance-menu-link\" aria-expanded=\"false\">About Us<\/a><button class=\"breakdance-menu-link-arrow\" type=\"button\" aria-expanded=\"false\" aria-label=\"About Us Submenu\"><\/button><\/div><div class=\"breakdance-dropdown-floater\" aria-hidden=\"true\">\n  <div class=\"breakdance-dropdown-body\">\n    <div class=\"breakdance-dropdown-section\">\n<ul class=\"breakdance-dropdown-links\">\n\t<li id=\"menu-item-634\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-634 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/why-choose-us\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Why Choose Us<\/span><\/a><\/li>\n\t<li id=\"menu-item-636\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-636 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/meet-the-team\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Meet The Team<\/span><\/a><\/li>\n\t<li id=\"menu-item-19\" class=\"menu-item menu-item-type-post_type menu-item-object-page current_page_parent menu-item-19 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/blog\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Blog<\/span><\/a><\/li>\n\t<li id=\"menu-item-1005\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1005 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/dentist-referral\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Dentist Referral<\/span><\/a><\/li>\n<\/ul>\n    <\/div>\n  <\/div>\n<\/div><\/li>\n<li id=\"menu-item-978\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-978 breakdance-menu-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/costs\/\" class=\"breakdance-menu-link\">Costs<\/a><\/li>\n<li id=\"menu-item-977\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-977 breakdance-menu-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/before-and-afters\/\" class=\"breakdance-menu-link\">Before and Afters<\/a><\/li>\n<li id=\"menu-item-791\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-791 breakdance-menu-item breakdance-dropdown breakdance-dropdown--wp breakdance-dropdown--with-link\"><div class=\"breakdance-dropdown-toggle\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/patient-information\/\" class=\"breakdance-menu-link\" aria-expanded=\"false\">Patient Information<\/a><button class=\"breakdance-menu-link-arrow\" type=\"button\" aria-expanded=\"false\" aria-label=\"Patient Information Submenu\"><\/button><\/div><div class=\"breakdance-dropdown-floater\" aria-hidden=\"true\">\n  <div class=\"breakdance-dropdown-body\">\n    <div class=\"breakdance-dropdown-section\">\n<ul class=\"breakdance-dropdown-links\">\n\t<li id=\"menu-item-799\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-799 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/your-treatment-journey\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Your Treatment Journey<\/span><\/a><\/li>\n\t<li id=\"menu-item-803\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-803 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/living-with-braces\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Living With Braces<\/span><\/a><\/li>\n\t<li id=\"menu-item-852\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-852 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/common-questions\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Common Questions<\/span><\/a><\/li>\n\t<li id=\"menu-item-869\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-869 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/orthodontic-glossary\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Orthodontic Glossary<\/span><\/a><\/li>\n\t<li id=\"menu-item-876\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-876 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/charity\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Charity<\/span><\/a><\/li>\n\t<li id=\"menu-item-879\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-879 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/medical-forms\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Medical Forms<\/span><\/a><\/li>\n<\/ul>\n    <\/div>\n  <\/div>\n<\/div><\/li>\n<li id=\"menu-item-940\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-940 breakdance-menu-item breakdance-dropdown breakdance-dropdown--wp breakdance-dropdown--with-link\"><div class=\"breakdance-dropdown-toggle\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/find-us\/\" class=\"breakdance-menu-link\" aria-expanded=\"false\">Find Us<\/a><button class=\"breakdance-menu-link-arrow\" type=\"button\" aria-expanded=\"false\" aria-label=\"Find Us Submenu\"><\/button><\/div><div class=\"breakdance-dropdown-floater\" aria-hidden=\"true\">\n  <div class=\"breakdance-dropdown-body\">\n    <div class=\"breakdance-dropdown-section\">\n<ul class=\"breakdance-dropdown-links\">\n\t<li id=\"menu-item-939\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-939 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/geelong\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Geelong<\/span><\/a><\/li>\n\t<li id=\"menu-item-938\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-938 breakdance-dropdown-item\"><a href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/hoppers-crossing\/\" class=\"breakdance-dropdown-link\"><span class=\"breakdance-dropdown-link__text\">Hoppers Crossing<\/span><\/a><\/li>\n<\/ul>\n    <\/div>\n  <\/div>\n<\/div><\/li>\n\n  <\/ul>\n  <\/nav>\n\n\n<\/div>\n<\/div><\/div><\/div>\n<\/section><section class=\"bde-section-1001-106 bde-section\">\n  \n  \n\t\n\n\n\n<div class=\"section-container\"><div class=\"bde-columns-1001-107 bde-columns\"><div class=\"bde-column-1001-108 bde-column\">\n  \n  \n\t\n\n\n\n<h1 class=\"bde-heading-1001-109 bde-heading\">\n<strong>Dentist <\/strong>referral \n<\/h1><div class=\"bde-text-1001-110 bde-text\">\nA copy of the information completed below will be emailed to you as a record.<br><br>The Braces N Faces Orthodontics welcomes patient referrals from dentists. If you would like to refer a patient to us for orthodontic treatment, please fill in the form below. We will ensure you are kept up-to-date and informed about any treatment plans.\n<\/div>\n<\/div><div class=\"bde-column-1001-111 bde-column\">\n  \n  \n\t\n\n\n\n<img decoding=\"async\" class=\"bde-image2-1001-112 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/05\/dentist-hero.jpg\" alt=\"dentist-hero\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/05\/dentist-hero.jpg 1410w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/05\/dentist-hero-300x147.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/05\/dentist-hero-1024x503.jpg 1024w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/05\/dentist-hero-768x377.jpg 768w\" sizes=\"(max-width: 1410px) 100vw, 1410px\">\n<\/div><\/div><\/div>\n<\/section><section class=\"bde-section-1001-156 bde-section\">\n  \n  \n\t\n\n\n\n<div class=\"section-container\"><div class=\"bde-div-1001-157 bde-div\">\n  \n  \n\t\n\n\n\n<div class=\"bde-text-1001-158 bde-text\">\nFields marked * are required.\n<\/div><h3 class=\"bde-heading-1001-160 bde-heading\">\nDentist's details\n<\/h3>\n<\/div><div class=\"bde-form-builder-1001-159 bde-form-builder\">\n\n<form id=\"contact-form159\" class=\"breakdance-form breakdance-form--vertical\" data-options=\"{&quot;slug&quot;:&quot;custom&quot;,&quot;name&quot;:&quot;Contact Form&quot;,&quot;ajaxUrl&quot;:&quot;https:\\\/\\\/elastic-mclaren.178-128-82-16.plesk.page\\\/wp-admin\\\/admin-ajax.php&quot;,&quot;clearOnSuccess&quot;:true,&quot;hideOnSuccess&quot;:false,&quot;successMessage&quot;:&quot;Your message has been received!&quot;,&quot;errorMessage&quot;:&quot;Something went wrong&quot;,&quot;redirect&quot;:false,&quot;redirectUrl&quot;:&quot;&quot;,&quot;customJavaScript&quot;:&quot;&quot;,&quot;recaptcha&quot;:{&quot;key&quot;:&quot;&quot;,&quot;enabled&quot;:false},&quot;honeypot_enabled&quot;:false,&quot;popupsOnSuccess&quot;:[],&quot;popupsOnError&quot;:[]}\" data-steps=\"0\" >\n  \n  \n  \n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"lytdbs\">\n            Dentist Name<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"lytdbs\"\n    aria-describedby=\"lytdbs\"\n    type=\"text\"\n    name=\"fields[lytdbs]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--email\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"yflmzf\">\n            Dentist Email<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"yflmzf\"\n    aria-describedby=\"yflmzf\"\n    type=\"email\"\n    name=\"fields[yflmzf]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"ncerss\">\n            Dentist Phone<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"ncerss\"\n    aria-describedby=\"ncerss\"\n    type=\"tel\"\n    name=\"fields[ncerss]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"tcheie\">\n            Practice Name<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"tcheie\"\n    aria-describedby=\"tcheie\"\n    type=\"text\"\n    name=\"fields[tcheie]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--textarea\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"eajizt\">\n            Practice Address<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <textarea\n    class=\"breakdance-form-field__input\"\n    id=\"eajizt\"\n    aria-describedby=\"eajizt\"\n    type=\"textarea\"\n    name=\"fields[eajizt]\"\n        rows=\"4\"\n        placeholder=\"\"\n    required\n    >\n<\/textarea>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--html\" >\n    \n    \n    \n    <div class=\"form-input-html\"\n    >\n  <h3>Patient's Details<\/h3>\n<\/div>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"nsazdi\">\n            First Name<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"nsazdi\"\n    aria-describedby=\"nsazdi\"\n    type=\"text\"\n    name=\"fields[nsazdi]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"nrxgjt\">\n            Last Name<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"nrxgjt\"\n    aria-describedby=\"nrxgjt\"\n    type=\"text\"\n    name=\"fields[nrxgjt]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"hrlmkw\">\n            Phone<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"hrlmkw\"\n    aria-describedby=\"hrlmkw\"\n    type=\"tel\"\n    name=\"fields[hrlmkw]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--select\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"qdmvkb\">\n            Patient date of birth<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <select\n    class=\"breakdance-form-field__input\"\n    id=\"qdmvkb\"\n    name=\"fields[qdmvkb]\"\n    required\n    \n        >\n      <option value=\"\">Select...<\/option>\n          <option value=\"1\" selected>1<\/option>\n        <option value=\"2\" >2<\/option>\n        <option value=\"3\" >3<\/option>\n        <option value=\"4\" >4<\/option>\n        <option value=\"5\" >5<\/option>\n        <option value=\"6\" >6<\/option>\n  <\/select>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--select\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"wgiiug\">\n            Days\n        <\/label>\n    \n    <select\n    class=\"breakdance-form-field__input\"\n    id=\"wgiiug\"\n    name=\"fields[wgiiug]\"\n    \n    \n        >\n      <option value=\"\">Select...<\/option>\n          <option value=\"Jan\" selected>Jan<\/option>\n        <option value=\"Feb\" >Feb<\/option>\n        <option value=\"April\" >April<\/option>\n        <option value=\"May\" >May<\/option>\n        <option value=\"June\" >June<\/option>\n        <option value=\"July\" >July<\/option>\n  <\/select>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--select\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"ltjoyn\">\n            Months\n        <\/label>\n    \n    <select\n    class=\"breakdance-form-field__input\"\n    id=\"ltjoyn\"\n    name=\"fields[ltjoyn]\"\n    \n    \n        >\n      <option value=\"\">Select...<\/option>\n          <option value=\"2026\" selected>2026<\/option>\n        <option value=\"2025\" >2025<\/option>\n        <option value=\"2024\" >2024<\/option>\n        <option value=\"2023\" >2023<\/option>\n        <option value=\"2022\" >2022<\/option>\n        <option value=\"2021\" >2021<\/option>\n  <\/select>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--email\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"czazlo\">\n            Email Address<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"czazlo\"\n    aria-describedby=\"czazlo\"\n    type=\"email\"\n    name=\"fields[czazlo]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"dolatj\">\n            Patients School \/ University\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"dolatj\"\n    aria-describedby=\"dolatj\"\n    type=\"text\"\n    name=\"fields[dolatj]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"bryehk\">\n            If patient is a minor, please give parent(s) or Guardian\u2019s names:\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"bryehk\"\n    aria-describedby=\"bryehk\"\n    type=\"text\"\n    name=\"fields[bryehk]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"uxoxxa\">\n            Patient lives with: Parent(s) \/ Mother \/ Father \/ Self \/Other*\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"uxoxxa\"\n    aria-describedby=\"uxoxxa\"\n    type=\"text\"\n    name=\"fields[uxoxxa]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"aaozfo\">\n            Family Dentist\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"aaozfo\"\n    aria-describedby=\"aaozfo\"\n    type=\"text\"\n    name=\"fields[aaozfo]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"xmphkc\">\n            Who referred you to our practice?\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"xmphkc\"\n    aria-describedby=\"xmphkc\"\n    type=\"text\"\n    name=\"fields[xmphkc]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Do you have a Medicare?*\"\n      >\n          <legend class=\"breakdance-form-field__label\">Do you have a Medicare?*<span class=\"breakdance-form-field__required\">*<\/span><\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[email][]\"\n                value=\"Yes\"\n                id=\"email-1\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"email-1\">Yes<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[email][]\"\n                value=\"No\"\n                id=\"email-2\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"email-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"message\">\n            If so, name of insurer<span class=\"breakdance-form-field__required\">*<\/span>\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"message\"\n    aria-describedby=\"message\"\n    type=\"text\"\n    name=\"fields[message]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    required\n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"xhaisd\">\n            Responsible Party First Name\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"xhaisd\"\n    aria-describedby=\"xhaisd\"\n    type=\"text\"\n    name=\"fields[xhaisd]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"afllml\">\n             Responsible Party Last Name\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"afllml\"\n    aria-describedby=\"afllml\"\n    type=\"text\"\n    name=\"fields[afllml]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--date\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"eckull\">\n            Date of Birth\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"eckull\"\n    aria-describedby=\"eckull\"\n    type=\"date\"\n    name=\"fields[eckull]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"hmbofi\">\n            Relationship\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"hmbofi\"\n    aria-describedby=\"hmbofi\"\n    type=\"text\"\n    name=\"fields[hmbofi]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"nsukmp\">\n            Home Address\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"nsukmp\"\n    aria-describedby=\"nsukmp\"\n    type=\"text\"\n    name=\"fields[nsukmp]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"pnasep\">\n            Postcode\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"pnasep\"\n    aria-describedby=\"pnasep\"\n    type=\"text\"\n    name=\"fields[pnasep]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"rjeyyx\">\n            Phone No (H)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"rjeyyx\"\n    aria-describedby=\"rjeyyx\"\n    type=\"tel\"\n    name=\"fields[rjeyyx]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"xxefhu\">\n            Phone No (W)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"xxefhu\"\n    aria-describedby=\"xxefhu\"\n    type=\"tel\"\n    name=\"fields[xxefhu]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"rrnoll\">\n            Phone No (M)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"rrnoll\"\n    aria-describedby=\"rrnoll\"\n    type=\"tel\"\n    name=\"fields[rrnoll]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"zzqnug\">\n            Employer\/s\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"zzqnug\"\n    aria-describedby=\"zzqnug\"\n    type=\"text\"\n    name=\"fields[zzqnug]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"hulyta\">\n             Occupation\/s\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"hulyta\"\n    aria-describedby=\"hulyta\"\n    type=\"text\"\n    name=\"fields[hulyta]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--html\" >\n    \n    \n    \n    <div class=\"form-input-html\"\n    >\n  <h3>Second Responsible Party Details<\/h3>\n<\/div>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"rzijqz\">\n            Responsible Party First Name\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"rzijqz\"\n    aria-describedby=\"rzijqz\"\n    type=\"text\"\n    name=\"fields[rzijqz]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"qkzbek\">\n            Responsible Party Last Name\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"qkzbek\"\n    aria-describedby=\"qkzbek\"\n    type=\"text\"\n    name=\"fields[qkzbek]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--date\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"zbizzv\">\n            Date of Birth\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"zbizzv\"\n    aria-describedby=\"zbizzv\"\n    type=\"date\"\n    name=\"fields[zbizzv]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"rmeipl\">\n            Relationship\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"rmeipl\"\n    aria-describedby=\"rmeipl\"\n    type=\"text\"\n    name=\"fields[rmeipl]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"rukpem\">\n            Home Address\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"rukpem\"\n    aria-describedby=\"rukpem\"\n    type=\"text\"\n    name=\"fields[rukpem]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"eppyni\">\n             Postcode\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"eppyni\"\n    aria-describedby=\"eppyni\"\n    type=\"text\"\n    name=\"fields[eppyni]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"nzbaxf\">\n            Phone No (H)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"nzbaxf\"\n    aria-describedby=\"nzbaxf\"\n    type=\"tel\"\n    name=\"fields[nzbaxf]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"vekdrl\">\n            Phone No (W)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"vekdrl\"\n    aria-describedby=\"vekdrl\"\n    type=\"tel\"\n    name=\"fields[vekdrl]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"gijqqs\">\n             Phone No (M)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"gijqqs\"\n    aria-describedby=\"gijqqs\"\n    type=\"tel\"\n    name=\"fields[gijqqs]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"lkscxk\">\n            Employer\/s\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"lkscxk\"\n    aria-describedby=\"lkscxk\"\n    type=\"text\"\n    name=\"fields[lkscxk]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"vkvaad\">\n            Occupation\/s\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"vkvaad\"\n    aria-describedby=\"vkvaad\"\n    type=\"text\"\n    name=\"fields[vkvaad]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Other than the responsible parties listed above, are there any other individuals or legal guardianship arrangements, in place that require specific consent for the patient to elect treatment and\/or who need to be involved in the ongoing management of the orthodontic treatment?*\"\n      >\n          <legend class=\"breakdance-form-field__label\">Other than the responsible parties listed above, are there any other individuals or legal guardianship arrangements, in place that require specific consent for the patient to elect treatment and\/or who need to be involved in the ongoing management of the orthodontic treatment?*<\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[epcnpo][]\"\n                value=\"Yes\"\n                id=\"epcnpo-1\"\n                \n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"epcnpo-1\">Yes (Our team will require a supplementary form to be completed)<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[epcnpo][]\"\n                value=\"No\"\n                id=\"epcnpo-2\"\n                \n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"epcnpo-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--html\" >\n    \n    \n    \n    <div class=\"form-input-html\"\n    >\n  <h3>Emergency Information<\/h3>\n<\/div>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"txwllr\">\n            Contact Person\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"txwllr\"\n    aria-describedby=\"txwllr\"\n    type=\"text\"\n    name=\"fields[txwllr]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--text\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"dubxmf\">\n            Relationship\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"dubxmf\"\n    aria-describedby=\"dubxmf\"\n    type=\"text\"\n    name=\"fields[dubxmf]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"utgnqr\">\n            Phone No (H)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"utgnqr\"\n    aria-describedby=\"utgnqr\"\n    type=\"tel\"\n    name=\"fields[utgnqr]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"zieqcg\">\n            Phone No (W)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"zieqcg\"\n    aria-describedby=\"zieqcg\"\n    type=\"tel\"\n    name=\"fields[zieqcg]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--tel\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"aizrzq\">\n            Phone No (M)\n        <\/label>\n    \n    <input\n    class=\"breakdance-form-field__input\"\n    id=\"aizrzq\"\n    aria-describedby=\"aizrzq\"\n    type=\"tel\"\n    name=\"fields[aizrzq]\"\n    placeholder=\"\"\n    value=\"\"\n                \n        \n        \n    \n    \n    \n    \n>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--html\" >\n    \n    \n    \n    <div class=\"form-input-html\"\n    >\n  <h3>General Information<\/h3>\n<\/div>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Has the patient had an orthodontic consultation before?\"\n      >\n          <legend class=\"breakdance-form-field__label\">Has the patient had an orthodontic consultation before?<span class=\"breakdance-form-field__required\">*<\/span><\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[hseedn][]\"\n                value=\"Yes\"\n                id=\"hseedn-1\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"hseedn-1\">Yes<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[hseedn][]\"\n                value=\"No\"\n                id=\"hseedn-2\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"hseedn-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Has the patient ever had orthodontic treatment?\"\n      >\n          <legend class=\"breakdance-form-field__label\">Has the patient ever had orthodontic treatment?<span class=\"breakdance-form-field__required\">*<\/span><\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[wceplm][]\"\n                value=\"Yes\"\n                id=\"wceplm-1\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"wceplm-1\">Yes<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[wceplm][]\"\n                value=\"No\"\n                id=\"wceplm-2\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"wceplm-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Any medical\/behavioural conditions, allergies or illnesses?\"\n      >\n          <legend class=\"breakdance-form-field__label\">Any medical\/behavioural conditions, allergies or illnesses?<span class=\"breakdance-form-field__required\">*<\/span><\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[nliuvu][]\"\n                value=\"Yes\"\n                id=\"nliuvu-1\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"nliuvu-1\">Yes<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[nliuvu][]\"\n                value=\"No\"\n                id=\"nliuvu-2\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"nliuvu-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Have you had any problems with dental treatment?\"\n      >\n          <legend class=\"breakdance-form-field__label\">Have you had any problems with dental treatment?<span class=\"breakdance-form-field__required\">*<\/span><\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[wcrhsc][]\"\n                value=\"Yes\"\n                id=\"wcrhsc-1\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"wcrhsc-1\">Yes<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[wcrhsc][]\"\n                value=\"No\"\n                id=\"wcrhsc-2\"\n                required\n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"wcrhsc-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Have any other family members had orthodontic treatment with us?\"\n      >\n          <legend class=\"breakdance-form-field__label\">Have any other family members had orthodontic treatment with us?<\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[lelwfd][]\"\n                value=\"Yes\"\n                id=\"lelwfd-1\"\n                \n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"lelwfd-1\">Yes<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[lelwfd][]\"\n                value=\"No\"\n                id=\"lelwfd-2\"\n                \n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"lelwfd-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--radio\" >\n    \n    \n    \n      <fieldset role=\"radiogroup\"\n          aria-label=\"Are you taking any prescribed medication\/s?\"\n      >\n          <legend class=\"breakdance-form-field__label\">Are you taking any prescribed medication\/s?<\/legend>\n                <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[xcgdcl][]\"\n                value=\"Yes\"\n                id=\"xcgdcl-1\"\n                \n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"xcgdcl-1\">Yes<\/label>\n        <\/div>\n            <div class=\"breakdance-form-radio\">\n            <input\n                type=\"radio\"\n                name=\"fields[xcgdcl][]\"\n                value=\"No\"\n                id=\"xcgdcl-2\"\n                \n                \n                            >\n            <label class=\"breakdance-form-radio__text\" for=\"xcgdcl-2\">No<\/label>\n        <\/div>\n      <\/fieldset>\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--checkbox\" >\n    \n    \n    \n    <fieldset role=\"group\"\n    >\n          <div class=\"breakdance-form-checkbox\">\n          <input\n              type=\"checkbox\"\n              name=\"fields[yuaobm]\"\n              value=\"understand \"\n              id=\"yuaobm-1\"\n              \n                        >\n          <label class=\"breakdance-form-checkbox__text\" for=\"yuaobm-1\">I understand that the above information will be kept strictly confidential.<\/label>\n      <\/div>\n  <\/fieldset>\n\n\n\n    \n    \n<\/div>\n\n\n<div class=\"breakdance-form-field breakdance-form-field--textarea\" >\n    \n    \n            <label class=\"breakdance-form-field__label\" for=\"gryank\">\n            Please sign here:\n        <\/label>\n    \n    <textarea\n    class=\"breakdance-form-field__input\"\n    id=\"gryank\"\n    aria-describedby=\"gryank\"\n    type=\"textarea\"\n    name=\"fields[gryank]\"\n        placeholder=\"\"\n    \n    >\n<\/textarea>\n\n\n    \n    \n<\/div>\n\n\n  \n\n<div class=\"breakdance-form-field breakdance-form-footer\">\n    \n    \n                                    \n    \n    \n    \n    \n            \n            <button type=\"submit\" class=\"button-atom button-atom--primary breakdance-form-button breakdance-form-button__submit\" disabled >\n    \n        <span class=\"button-atom__text\">Submit<\/span>\n\n        \n        \n            <\/button>\n    \n    <input type=\"hidden\" name=\"form_id\" value=\"159\">\n    <input type=\"hidden\" name=\"post_id\" value=\"1001\">\n<\/div>\n\n  \n<\/form>\n\n\n<\/div><\/div>\n<\/section><section class=\"bde-section-1001-113 bde-section\">\n  \n  \n\t\n\n\n\n<div class=\"section-container\"><div class=\"bde-columns-1001-114 bde-columns\"><div class=\"bde-column-1001-115 bde-column\">\n  \n  \n\t\n\n\n\n<h2 class=\"bde-heading-1001-116 bde-heading\">\nFollow Us!\n<\/h2><div class=\"bde-text-1001-117 bde-text\">\nGet social with Braces N Faces Orthodontics\n<\/div>\n<\/div><div class=\"bde-column-1001-118 bde-column\">\n  \n  \n\t\n\n\n\n<div class=\"bde-div-1001-119 bde-div\">\n  \n  \n\t\n\n\n\n<div class=\"bde-icon-1001-120 bde-icon\">\n\n    \n                    \n            \n            \n\n    \n    \n    \n    \n    \n    <a class=\"breakdance-link bde-icon-icon breakdance-icon-atom\" href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/\" target=\"_self\" data-type=\"url\"  >\n\n    \n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" id=\"icon-facebook\" viewBox=\"0 0 32 32\">\n<path d=\"M19 6h5v-6h-5c-3.86 0-7 3.14-7 7v3h-4v6h4v16h6v-16h5l1-6h-6v-3c0-0.542 0.458-1 1-1z\"\/>\n<\/svg>\n        \n        \n        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Font Awesome Free 6.5.1 by @fontawesome - https:\/\/fontawesome.com License - https:\/\/fontawesome.com\/license\/free (Icons: CC BY 4.0, Fonts: SIL OFL 1.1, Code: MIT License) Copyright 2023 Fonticons, Inc. --><path d=\"M224.1 141c-63.6 0-114.9 51.3-114.9 114.9s51.3 114.9 114.9 114.9S339 319.5 339 255.9 287.7 141 224.1 141zm0 189.6c-41.1 0-74.7-33.5-74.7-74.7s33.5-74.7 74.7-74.7 74.7 33.5 74.7 74.7-33.6 74.7-74.7 74.7zm146.4-194.3c0 14.9-12 26.8-26.8 26.8-14.9 0-26.8-12-26.8-26.8s12-26.8 26.8-26.8 26.8 12 26.8 26.8zm76.1 27.2c-1.7-35.9-9.9-67.7-36.2-93.9-26.2-26.2-58-34.4-93.9-36.2-37-2.1-147.9-2.1-184.9 0-35.8 1.7-67.6 9.9-93.9 36.1s-34.4 58-36.2 93.9c-2.1 37-2.1 147.9 0 184.9 1.7 35.9 9.9 67.7 36.2 93.9s58 34.4 93.9 36.2c37 2.1 147.9 2.1 184.9 0 35.9-1.7 67.7-9.9 93.9-36.2 26.2-26.2 34.4-58 36.2-93.9 2.1-37 2.1-147.8 0-184.8zM398.8 388c-7.8 19.6-22.9 34.7-42.6 42.6-29.5 11.7-99.5 9-132.1 9s-102.7 2.6-132.1-9c-19.6-7.8-34.7-22.9-42.6-42.6-11.7-29.5-9-99.5-9-132.1s-2.6-102.7 9-132.1c7.8-19.6 22.9-34.7 42.6-42.6 29.5-11.7 99.5-9 132.1-9s102.7-2.6 132.1 9c19.6 7.8 34.7 22.9 42.6 42.6 11.7 29.5 9 99.5 9 132.1s2.7 102.7-9 132.1z\"\/><\/svg>\n        \n        \n        \n                <\/a>\n\n    \n\n\n<\/div><div class=\"bde-icon-1001-122 bde-icon\">\n\n    \n                    \n            \n            \n\n    \n    \n    \n    \n    \n    <a class=\"breakdance-link bde-icon-icon breakdance-icon-atom\" href=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/\" target=\"_self\" data-type=\"url\"  >\n\n    \n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" id=\"icon-youtube2\" viewBox=\"0 0 80 32\">\n<path d=\"M10.75 5.294c0.007-0.027 0.011-0.046 0.012-0.056l0.033-0.236-1.48-0.008c-1.337-0.008-1.746 0-1.783 0.034-0.018 0.016-0.479 1.77-1.302 4.946-0.392 1.515-0.723 2.725-0.734 2.689s-0.481-1.766-1.044-3.843c-0.563-2.078-1.034-3.789-1.048-3.803-0.019-0.019-1.812-0.028-3.263-0.016-0.21 0.002-0.327-0.41 1.876 6.598 0.305 0.97 0.762 2.344 1.015 3.052 0.292 0.817 0.5 1.448 0.642 1.974 0.251 1.002 0.26 1.63 0.205 2.363-0.063 0.847-0.073 6.826-0.011 6.926 0.047 0.077 2.851 0.112 3.116 0.040 0.042-0.012 0.071-0.053 0.090-0.279 0.066-0.194 0.071-0.968 0.071-4.18v-4.103l0.179-0.566c0.117-0.37 0.413-1.344 0.656-2.163s0.538-1.801 0.654-2.18c1.057-3.447 2.067-6.838 2.094-7.032l0.022-0.158z\"\/>\n<path d=\"M26.441 10.27l-0.001 0.214-0.033 0-0.019 5.906-0.018 5.726-0.458 0.467c-0.513 0.522-0.925 0.722-1.297 0.629-0.405-0.102-0.395 0.056-0.429-6.712l-0.031-6.23h-2.947v0.214h-0.034v6.759c0 7.242-0 7.237 0.367 7.965 0.293 0.579 0.719 0.861 1.45 0.958h0c0.962 0.128 2-0.308 2.962-1.244l0.418-0.407v0.701c0 0.606 0.017 0.706 0.127 0.737 0.18 0.050 2.412 0.053 2.653 0.004l0.2-0.041v-0.207l0.034-0.007v-15.472l-2.944 0.039z\"\/>\n<path d=\"M18.965 13.323c-0.279-1.198-0.802-2.004-1.664-2.561-1.353-0.875-2.897-0.967-4.331-0.259-1.045 0.516-1.717 1.372-2.065 2.628-0.041 0.15-0.072 0.275-0.095 0.463-0.088 0.443-0.099 1.105-0.122 4.186-0.035 4.748 0.019 5.313 0.614 6.391 0.583 1.058 1.794 1.833 3.112 1.993 0.397 0.048 1.201-0.027 1.663-0.155 1.051-0.291 2.058-1.122 2.504-2.065 0.192-0.407 0.309-0.691 0.379-1.208 0.13-0.707 0.14-1.849 0.14-4.762-0-3.715-0.012-4.121-0.136-4.651zM15.604 23c-0.247 0.188-0.679 0.27-1.031 0.195-0.271-0.058-0.636-0.482-0.748-0.869-0.14-0.482-0.151-7.187-0.030-8.502 0.199-0.658 0.756-1.002 1.364-0.838 0.474 0.128 0.716 0.424 0.854 1.046 0.103 0.461 0.115 1.035 0.093 4.414-0.014 2.241-0.022 3.336-0.096 3.924-0.074 0.371-0.197 0.47-0.407 0.63z\"\/>\n<path d=\"M71.887 16.692h1.424l-0.023-1.29c-0.022-1.183-0.039-1.319-0.198-1.64-0.249-0.507-0.617-0.731-1.201-0.731-0.701 0-1.146 0.339-1.356 1.036-0.089 0.296-0.183 2.334-0.116 2.51 0.038 0.098 0.241 0.116 1.469 0.116z\"\/>\n<path d=\"M62.369 13.757c-0.19-0.383-0.543-0.571-0.954-0.556-0.319 0.011-0.674 0.146-1.015 0.407l-0.254 0.193v9.269l0.254 0.193c0.576 0.439 1.209 0.532 1.644 0.241 0.172-0.115 0.285-0.274 0.372-0.527 0.114-0.329 0.124-0.75 0.109-4.649-0.015-4.064-0.024-4.303-0.157-4.57z\"\/>\n<path d=\"M80.027 9.582c-0.284-3.401-0.509-4.505-1.211-5.923-0.929-1.878-2.272-2.868-4.184-3.086-1.478-0.168-7.041-0.405-12.189-0.52-8.912-0.198-23.564 0.183-25.436 0.662-0.865 0.221-1.513 0.597-2.188 1.269-1.183 1.177-1.887 2.865-2.17 5.2-0.647 5.331-0.66 11.773-0.037 17.297 0.268 2.376 0.82 3.92 1.857 5.192 0.647 0.794 1.761 1.469 2.758 1.67 0.7 0.141 4.201 0.337 9.3 0.521 0.76 0.027 2.771 0.074 4.47 0.105 3.541 0.063 10.051 0.026 13.772-0.079 2.504-0.070 7.069-0.255 7.922-0.321 0.24-0.019 0.796-0.054 1.236-0.079 1.477-0.083 2.417-0.393 3.3-1.086 1.142-0.897 2.027-2.556 2.4-4.501 0.354-1.84 0.59-5.118 0.638-8.839 0.040-3.109-0.013-4.787-0.238-7.482zM44.54 8.35l-1.656 0.020-0.073 17.661-1.435 0.018c-1.11 0.015-1.447-0.001-1.474-0.073-0.019-0.051-0.042-4.032-0.052-8.849l-0.018-8.758-3.234-0.041v-2.76l9.557 0.039 0.041 2.721-1.656 0.020zM54.694 18.472v7.595h-2.616v-0.799c0-0.601-0.023-0.799-0.093-0.799-0.051 0-0.288 0.198-0.527 0.441-0.517 0.526-1.13 0.949-1.653 1.145-1.083 0.405-2.112 0.169-2.551-0.586-0.401-0.691-0.409-0.845-0.409-8.010v-6.58h2.614l0.020 6.196c0.019 6.088 0.022 6.2 0.168 6.448 0.193 0.329 0.488 0.417 0.956 0.288 0.276-0.076 0.464-0.21 0.911-0.654l0.563-0.561v-11.717h2.616v7.595zM64.899 24.982c-0.23 0.513-0.744 1.016-1.165 1.14-1.099 0.324-1.98 0.060-2.998-0.897-0.316-0.297-0.61-0.538-0.654-0.538-0.053 0-0.082 0.233-0.082 0.69v0.69h-2.616v-20.495h2.616v3.343c0 1.839 0.025 3.343 0.054 3.343s0.306-0.244 0.613-0.541c0.707-0.683 1.298-0.981 2.049-1.038 1.338-0.101 2.135 0.587 2.501 2.16 0.114 0.491 0.125 1.051 0.125 5.596-0 5.537-0.001 5.56-0.443 6.546zM75.968 21.943c-0.023 0.57-0.092 1.223-0.154 1.454-0.364 1.349-1.332 2.304-2.732 2.696-1.885 0.527-3.96-0.337-4.788-1.994-0.465-0.93-0.481-1.116-0.481-5.662 0-3.707 0.013-4.162 0.132-4.667 0.336-1.431 1.168-2.357 2.578-2.871 0.408-0.149 0.835-0.225 1.261-0.234 1.521-0.031 3.031 0.787 3.663 2.119 0.427 0.899 0.48 1.283 0.522 3.816l0.039 2.271-5.578 0.039-0.020 1.526c-0.029 2.153 0.116 2.815 0.697 3.207 0.489 0.329 1.24 0.305 1.649-0.055 0.383-0.337 0.491-0.698 0.529-1.753l0.034-0.927h2.694l-0.043 1.036z\"\/>\n<\/svg>\n        \n        \n        \n                <\/a>\n\n    \n\n\n<\/div>\n<\/div>\n<\/div><\/div><div class=\"bde-grid-1001-123 bde-grid\">\n  \n  \n\t\n\n\n\n<div class=\"bde-div-1001-124 bde-div\">\n  \n  \n\t\n\n\n\n<img decoding=\"async\" class=\"bde-image2-1001-125 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-01.jpg\" alt=\"insta-01\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-01.jpg 1080w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-01-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-01-1024x1024.jpg 1024w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-01-150x150.jpg 150w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-01-768x768.jpg 768w\" sizes=\"(max-width: 1080px) 100vw, 1080px\">\n<\/div><div class=\"bde-div-1001-126 bde-div\">\n  \n  \n\t\n\n\n\n<div class=\"bde-grid-1001-127 bde-grid\">\n  \n  \n\t\n\n\n\n<img decoding=\"async\" class=\"bde-image2-1001-128 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-02.jpg\" alt=\"insta-02\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-02.jpg 1080w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-02-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-02-1024x1024.jpg 1024w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-02-150x150.jpg 150w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-02-768x768.jpg 768w\" sizes=\"(max-width: 1080px) 100vw, 1080px\"><img decoding=\"async\" class=\"bde-image2-1001-129 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-03.jpg\" alt=\"insta-03\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-03.jpg 1080w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-03-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-03-1024x1024.jpg 1024w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-03-150x150.jpg 150w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-03-768x768.jpg 768w\" sizes=\"(max-width: 1080px) 100vw, 1080px\"><img decoding=\"async\" class=\"bde-image2-1001-130 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-06.jpg\" alt=\"insta-06\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-06.jpg 720w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-06-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-06-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\"><img decoding=\"async\" class=\"bde-image2-1001-131 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-07.jpg\" alt=\"insta-07\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-07.jpg 1058w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-07-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-07-1024x1024.jpg 1024w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-07-150x150.jpg 150w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-07-768x768.jpg 768w\" sizes=\"(max-width: 1058px) 100vw, 1058px\">\n<\/div>\n<\/div><div class=\"bde-div-1001-132 bde-div\">\n  \n  \n\t\n\n\n\n<div class=\"bde-grid-1001-133 bde-grid\">\n  \n  \n\t\n\n\n\n<img decoding=\"async\" class=\"bde-image2-1001-134 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-04.jpg\" alt=\"insta-04\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-04.jpg 720w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-04-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-04-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\"><img decoding=\"async\" class=\"bde-image2-1001-135 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-05.jpg\" alt=\"insta-05\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-05.jpg 1080w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-05-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-05-1024x1024.jpg 1024w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-05-150x150.jpg 150w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-05-768x768.jpg 768w\" sizes=\"(max-width: 1080px) 100vw, 1080px\"><img decoding=\"async\" class=\"bde-image2-1001-136 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-08.jpg\" alt=\"insta-08\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-08.jpg 720w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-08-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-08-150x150.jpg 150w\" sizes=\"(max-width: 720px) 100vw, 720px\"><img decoding=\"async\" class=\"bde-image2-1001-137 bde-image2\" src=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-09.jpg\" alt=\"insta-09\" loading=\"lazy\" srcset=\"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-09.jpg 714w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-09-300x300.jpg 300w, https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/wp-content\/uploads\/2026\/03\/insta-09-150x150.jpg 150w\" sizes=\"(max-width: 714px) 100vw, 714px\">\n<\/div>\n<\/div>\n<\/div><\/div>\n<\/section><section class=\"bde-section-1001-138 bde-section\">\n  \n  \n\t\n\n\n\n<div class=\"section-container\"><div class=\"bde-google-map-1001-139 bde-google-map breakdance-free-version-frontend-element-hider\">\r\n<iframe width=\"100%\" height=\"100%\" style=\"border:0\" loading=\"lazy\" title=\"Map\" src=\"https:\/\/maps.google.com\/maps?q=452-456+Latrobe+Terrace%3Cbr%3ENewtown%3Cbr%3EVIC%3Cbr%3E3220&t=m&z=18&output=embed&iwloc=near\" allowfullscreen><\/iframe>\n<\/div><div class=\"bde-columns-1001-140 bde-columns\"><div class=\"bde-column-1001-141 bde-column\">\n  \n  \n\t\n\n\n\n<h2 class=\"bde-heading-1001-142 bde-heading\">\nVisit Us\n<\/h2><h5 class=\"bde-heading-1001-143 bde-heading\">\nGeelong\n<\/h5><a class=\"bde-text-link-1001-144 bde-text-link breakdance-link\" href=\"https:\/\/breakdance.com\/\" target=\"_self\" data-type=\"url\">\n  <h6 >\n  92 Derrimut Rd<br>Hoppers Crossing<br>VIC<br>3029\n  <\/h6>\n\n<\/a><div class=\"bde-div-1001-145 bde-div\">\n  \n  \n\t\n\n\n\n<div class=\"bde-icon-1001-146 bde-icon\">\n\n    \n            <div class=\"bde-icon-icon breakdance-icon-atom\" >\n    \n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" id=\"icon-phone\" viewBox=\"0 0 32 32\">\n<path d=\"M22 20c-2 2-2 4-4 4s-4-2-6-4-4-4-4-6 2-2 4-4-4-8-6-8-6 6-6 6c0 4 4.109 12.109 8 16s12 8 16 8c0 0 6-4 6-6s-6-8-8-6z\"\/>\n<\/svg>\n        \n        \n        \n            <\/div>\n    \n\n\n<\/div><a class=\"bde-text-link-1001-147 bde-text-link breakdance-link\" href=\"https:\/\/breakdance.com\/\" target=\"_self\" data-type=\"url\">\n  <h6 >\n  (03) 9748 9224\n  <\/h6>\n\n<\/a>\n<\/div><a class=\"bde-text-link-1001-148 bde-text-link breakdance-link\" href=\"https:\/\/breakdance.com\/\" target=\"_self\" data-type=\"url\">\n  <h6 >\n  Directions & Opening Times\n  <\/h6>\n\n<\/a>\n<\/div><div class=\"bde-column-1001-149 bde-column\">\n  \n  \n\t\n\n\n\n<h5 class=\"bde-heading-1001-150 bde-heading\">\nHoppers Crossing\n<\/h5><a class=\"bde-text-link-1001-151 bde-text-link breakdance-link\" href=\"https:\/\/breakdance.com\/\" target=\"_self\" data-type=\"url\">\n  <h6 >\n  92 Derrimut Rd<br>Hoppers Crossing<br>VIC<br>3029\n  <\/h6>\n\n<\/a><div class=\"bde-div-1001-152 bde-div\">\n  \n  \n\t\n\n\n\n<div class=\"bde-icon-1001-153 bde-icon\">\n\n    \n            <div class=\"bde-icon-icon breakdance-icon-atom\" >\n    \n                    <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" id=\"icon-phone\" viewBox=\"0 0 32 32\">\n<path d=\"M22 20c-2 2-2 4-4 4s-4-2-6-4-4-4-4-6 2-2 4-4-4-8-6-8-6 6-6 6c0 4 4.109 12.109 8 16s12 8 16 8c0 0 6-4 6-6s-6-8-8-6z\"\/>\n<\/svg>\n        \n        \n        \n            <\/div>\n    \n\n\n<\/div><a class=\"bde-text-link-1001-154 bde-text-link breakdance-link\" href=\"https:\/\/breakdance.com\/\" target=\"_self\" data-type=\"url\">\n  <h6 >\n  (03) 9748 9224\n  <\/h6>\n\n<\/a>\n<\/div><a class=\"bde-text-link-1001-155 bde-text-link breakdance-link\" href=\"https:\/\/breakdance.com\/\" target=\"_self\" data-type=\"url\">\n  <h6 >\n  Directions & Opening Times\n  <\/h6>\n\n<\/a>\n<\/div><\/div><\/div>\n<\/section>","protected":false},"excerpt":{"rendered":"<p>Home Booking Treatments Invisalign For Adults Invisalign For Teens Invisalign First Braces For Adults Braces For Children and Teens About Us Why Choose Us Meet The Team Blog Dentist Referral Costs Before and Afters Patient Information Your Treatment Journey Living With Braces Common Questions Orthodontic Glossary Charity Medical Forms Find Us Geelong Hoppers Crossing Dentist [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_breakdance_hide_in_design_set":false,"_breakdance_tags":"","footnotes":""},"class_list":["post-1001","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/pages\/1001","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/comments?post=1001"}],"version-history":[{"count":12,"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/pages\/1001\/revisions"}],"predecessor-version":[{"id":1015,"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/pages\/1001\/revisions\/1015"}],"wp:attachment":[{"href":"https:\/\/elastic-mclaren.178-128-82-16.plesk.page\/index.php\/wp-json\/wp\/v2\/media?parent=1001"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}