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Orthodontic Questionnaire
 
In order to provide you a virtual consultation and assess your dental concerns, please submit your information below. 
 
Your information will be securely sent back to our team to evaluate.  
 
 
 
Smile & Profile
Please Take The Above Photos
Upload or drag files here
Overbite & Overjet
Please Take The Above Photos

Left:     Bite all the way down on your back teeth. Do not push your lower jaw forward.
Right:   Bite all the way down on your back teeth.  Take a side view showing top/bottom front teeth.
Upload or drag files here
Upper Arch & Lower Arch
Please Take The Above Photos

Left:     Open as wide as possible to get the underside of your upper teeth.
Right:   Aim over the top of your lower teeth.  Pull your lower lip down.
Upload or drag files here
Right Bite & Left Bite
Please Take The Above Photos

Bite all the way down on your back teeth.  Take right and left view of your back teeth.
Upload or drag files here
Done