First name *
Last name *
E-mail *
Phone number *
Address *
Postal code *
City *
Select an option * payment arrangement 100 euro (€ 100,00) payment arrangement 50 euro (€ 50,00) retention check-up fixed appliance in 2 jaws (F533A) (€ 43,74) retention check-up fixed appliance in 1 jaw (F532A) (€ 34,99) (overview) x-ray assessment (F156A) (€ 18,46) (overview) x-ray manufacture (F155A) (€ 31,49) braces consultation from the 25th month of treatment (F521A) (€ 30,62) braces consultation fixes appliance in 2 jaws (category 6: F516A) (€ 43,74) braces consultation fixed appliance in 1 jaw (category 5: F515A) (€ 34,99) removable braces consultation (category 1 t/m 4: F511A t/m F514A) (€ 30,62) removing braces category 5/6/7, per jaw - F492A (€ 100,74) place braces category 2 (HG) (€ 173,51) place braces category 2 (TPA) (€ 159,94) place braces category 2 (HG+TPA) (€ 175,00) place braces category 3 (Twin-block) (€ 273,38) place braces category 3 (Twin-block+HG) (€ 303,44) place braces category 3 (New T-appliance) (€ 292,58) place braces category 2 (Hyrax) (€ 293,41) place braces category 5 (lock-braces in 1 jaw) (€ 399,92) place braces category 6 (lock-braces in 2 jaws) (€ 662,57)
Amount * €
Payment method * iDEAL I hereby give authorization to collect the recurring amount from my account periodically.
Sumbit