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Enter some information, snap a few pics and then we’ll be in touch to chat with you about your treatment options.

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#1 Upper Teeth

Open your mouth wide and lift your chin as high as you can. Hold the camera so that it’s perpendicular to the biting surfaces of your top teeth. Make sure you can see the full arch and then click.
#2 Lower Teeth

Open your mouth wide and tilt your chin downwards toward your chest. Hold the camera so it’s perpendicular to the biting surfaces of your bottom teeth. Make sure your full arch is showing and then snap a picture.
#3 Front View, smiling

Bite down so your back teeth touch. Directly facing the camera and smile wide, trying to get as many teeth as you can in the picture. If you need to, you can pull your lips and cheeks away from your teeth with your fingers to show more teeth.
#4 Right View

Bite down so that your back teeth touch, smile and retract the cheek and lips with your finger on the right side of your mouth to expose more of your teeth. Take a picture of the right side.
#5 Left View

Bite down so that your back teeth touch, smile and retract the cheek and lips with your finger on the left side of your mouth to expose more of your teeth. Take a picture of the left side.

Who Referred You?

Name of Your Dentist

Who is Your Insurance Provider?

What treatment would you like?
Limited Treatment (Braces or clear aligners, minor corrections only)Comprehensive Treatment (Braces or Clear Aligners, complete alignment of all teeth and bite correction)

Have you worn braces or invisible aligners in the past?
YesNo

Choose the option that best describes your biggest concern with your smile:

Of the images below, which one best describes your teeth crowding?
Mild or NoneModerateSevere
Of the images below, which one best describes your teeth spacing?
Mild or NoneModerateSevere