Request a Virtual Consultation

Patient Status *

Are you a current patient?

Current Patient
New Patient
No elements found. Consider changing the search query.
List is empty.

Who is it for? (Select One) *

My Child (7 - 11yr)

My Teenager (12 - 18yr)

Adult (18+)

I feel like my teeth are ____________.(Please choose up to two option(s) below) *

Overbite

Underbite

Crossbite

Crooked Teeth

Open Bite

Gap Teeth

Other

Full Name *

Date of birth

Phone *

Email *

Comments

Upload Your Photos:

All photos should be taken sitting in a seated position. You will need a friend or family member to serve as your photographer as it's difficult to try and take each of the photos below by yourself.

Images must be a .jpg, .png, or .gif and cannot exceed 20MB.

Front Teeth Biting Down *

Upload Front Teeth Biting Down

Accepted file types: .jpg, .png, or .gif

Right Back Teeth Biting Down *

Upload Right Back Teeth Biting Down

Accepted file types: .jpg, .png, or .gif

Left Back Teeth Biting Down *

Upload Left Back Teeth Biting Down

Accepted file types: .jpg, .png, or .gif

Top Teeth *

Upload Top Teeth

Accepted file types: .jpg, .png, or .gif

Bottom Teeth *

Upload Bottom Teeth

Accepted file types: .jpg, .png, or .gif

Front Teeth Slightly Opened *

Upload Front Teeth Slightly Opened

Accepted file types: .jpg, .png, or .gif