Virtual Smile Assessment

Step 1 / 4
First Name*
Last Name*
E-Mail
Phone*
Age
I verify that I am at least 18 years old
Fill Required Fields
Step 2 / 4
Do you have dental insurance?*
Do you qualify for medicaid?*
Have you had braces before?*
Treatment Preference*
ex. Braces, Invisalign, etc
What would you like fixed about your smile?*
Ex. crowding, spacing, etc.
Step 3 / 4- Upload Your Photos
Please have another person take photos of your smile for you in the various positions described below. Images must be a .jpeg, .png, or .gif and cannot exceed 20MB.
Photo 1
Front Smile Photo
Use spoons to pull back your cheeks and bite down on back teeth
Photo 2
Right Smile Photo
Using spoons, relax left side and pull spoon back on right side. Please show teeth from the right (bite down on back teeth)
Photo 3
Left Smile Photo
Using spoons, relax right side and pull spoon back on left side. Please show teeth from the left (bite down on back teeth)
Front Side Photo*
Maximum file size: 5 MB
Right Side Photo*
Maximum file size: 5 MB
Left Side Photo*
Maximum file size: 5 MB
Please upload all 3 pictures
Step 4 / 4
Additional Comments
Almost Finished!
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