Plan Your Costa Rica Trip | Divergent Escapes

Dental discovery intake

Fields marked * help us begin the nonclinical coordination conversation. Your dental clinic independently determines candidacy, records needed, treatment, consent, pricing, and clinical care.

Full name *

Email address *

Preferred contact method *EmailPhoneWhatsApp

Phone number *

Full address

WhatsApp number (optional)

Only if you use WhatsApp and the number differs from your phone number. Include your country code.

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal code *

Country *

What would you like the clinical team to understand? *

When would you ideally travel?

Information available to shareI have a recent panoramic X-ray or CBCT scan.I have a current treatment plan, X-ray report, or dental notes.I can provide requested smile or tooth photos.I can share relevant health information and current medications with the clinical team.

Upload records or images, if available

Optional. You can begin without attachments; the clinical team will explain any records needed for review. PDF, JPG, JPEG, or PNG. Up to 8 MB per file. Do not send medical records through ordinary email.

Let’s begin your Costa Rica experience.