Form

Invisalign Consult Appointment Request

Join us for our Invisalign Week (Oct 24 - Oct 31)
Invisalign is offering free at-home whitening and vivera retainers to the first 10 patients who accept treatment!

Fill out the information below and our office will call you to schedule your consultation!

First Name

Last Name

Date Of Birth

Are you a current patient of our office?

Have you had previous orthodontic treatment?

Address

City

Zip Code

Phone

Date

Thank you for your interest! Our front desk will be calling soon to schedule your consultation! Please note the consultation is complimentary, however if you wish to move forward with a custom treatment plan there will be a treatment planning fee of $150 that will be used toward treatment cost should you decide accept. If you have any questions regarding invisalign before your appointment please visit our website or ask our front desk for more information!