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) (€ 52,15) retention check-up fixed appliance in 1 jaw (F532A) (€ 41,71) (overview) x-ray assessment (F156A) (€ 37,54) (overview) x-ray manufacture (F155A) (€ 22,00) (lateral) x-ray assessment (F157A) (€ 23,51) (lateral) x-ray manufacture (F158A) (€ 65,64) braces consultation from the 25th month of treatment (F521A) (€ 36,50) braces consultation fixes appliance in 2 jaws (category 6: F516A) (€ 52,14) braces consultation fixed appliance in 1 jaw (category 5: F515A) (€ 41,71) removable braces consultation (category 1 t/m 4: F511A t/m F514A) (€ 36,50) removing braces category 5/6/7, per jaw - F492A (€ 120,08) place braces category 1 (all plates) (€ 234,05) place braces category 1 (active hawley or acco) (€ 214,71) place braces category 2 (HG) (€ 190,56) place braces category 2 (TPA) (€ 178,23) place braces category 2 (HG+TPA) (€ 192,20) place braces category 3 (Twin-block) (€ 325,06) place braces category 3 (Twin-block+HG) (€ 374,75) place braces category 3 (New T-appliance) (€ 400,94) place braces category 2 (Hyrax) (€ 332,02) place braces category 4 (Herbst) (€ 515,10) place braces category 4 (Herbst-hyrax) (€ 597,06) place braces category 4 (Herbst with under plate) (€ 515,17) place braces category 4 (Herbst-hyrax with under plate) (€ 546,77) place braces category 5 (lock-braces in 1 jaw) (€ 469,07) place braces category 6 (lock-braces in 2 jaws) (€ 774,53) place extra retention brace IOR (€ 105,29) place extra retention brace Hawley (€ 121,17)
Amount * €
Payment method * iDEAL I hereby give authorization to collect the recurring amount from my account periodically.
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