Create New Request
Repair or lost denture replacement
1
Patient
2
Repair
3
Photos
4
Timing
5
Review
Step 1 of 5
Request and Patient
Choose what you need, then provide your best contact details.
What do you need?
Repair a broken denture
Cracked, broken, loose, or missing tooth on a denture you still have.
Replace a lost denture
Submit details for clinic review and timing confirmation.
Your contact details are used to manage this request, send clinic updates, and maintain your patient record.
First name
Last name
Mobile number
Email address
Preferred contact method
Phone call
We can call you if details need checking.
SMS
Fast text updates for request progress.
Email
Written updates with request details.
Address
Step 2 of 5
Denture Details
Tell us what happened so the clinic can prepare.
Denture age
Choose one
Less than 1 year
1 to 3 years
4 to 7 years
8+ years
Not sure
Previous repairs
Choose one
Yes
No
Not sure
Previous repair notes
Damage type
Cracked denture
A visible split or fracture.
Broken tooth
A tooth has chipped or detached.
Broken base
The plate or base has broken.
Loose fit
The denture no longer sits firmly.
Missing tooth
One or more teeth are missing.
Other damage
Something else needs review.
Use this option if the denture is lost and you need express replacement help without calling first.
Replacement denture type
Full denture
A complete upper or lower denture.
Partial denture
A denture replacing some teeth.
Implant retained
A denture that attaches to implants.
Flexible denture
A lightweight flexible denture.
Not sure
The clinic can confirm this with you.
Which denture was lost?
Upper denture
Top denture.
Lower denture
Bottom denture.
Both upper and lower
Both dentures are missing.
Not sure
The clinic can check with you.
When was it lost?
Did this clinic make the original?
Choose one
Yes
No
Not sure
Replacement notes
Urgency level
Same-day requested
Request review for today. Availability is confirmed by the clinic.
Within 24 hours
Urgent but not immediate.
Within 48 hours
Soon, but flexible.
Flexible
Book the next suitable time.
Damage description
Step 3 of 5
Upload Denture Photos
Clear photos help the clinic review the request faster.
Add Denture Photos
Use your camera or gallery. JPG, PNG, or WebP. Up to 8 photos, 20 MB each.
Denture photos are stored privately and used by authorised clinic staff to assess and complete this request.
Front view
Back view
Left side
Right side
Step 4 of 5
Preferred Completion Time
Tell us how urgently you need clinic help.
Preferred completion time
We will use your preferred contact method for request updates when notifications are configured.
Step 5 of 5
Review Request
Check your details before sending them to the clinic.
Your request summary will appear here.
Complete the previous steps to review your details.
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Submit Request
Uploading your request
Please keep this page open while photos are sent.