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