Digital Consultation Form First Name**Last Name**Email** Phone**Age**Additional Information#1 Lower Teeth**Open your mouth wide and tilt your chin downwards toward your chest. Hold the camera so it’s perpendicular to the biting surfaces of your bottom teeth. Make sure your full arch is showing and then snap a picture.#2 Upper Teeth**Open your mouth wide and lift your chin as high as you can. Hold the camera so that it’s perpendicular to the biting surfaces of your top teeth. Make sure you can see the full arch and then click.#3 Front View, smiling**Bite down so your back teeth touch. Directly facing the camera, smile wide and click, trying to get as many teeth as you can in the picture. If you need to, you can pull your lips and cheeks away from your teeth with your fingers to show more teeth.#4 Right View**Bite down so that your back teeth touch, smile and retract the cheek and lips with your finger on the right side of your mouth to expose more of your teeth. Take a picture of the right side.#5 Left View**Bite down so that your back teeth touch, smile and retract the cheek and lips with your finger on the left side of your mouth to expose more of your teeth. Take a picture of the left side.Your Preferred Office LocationChoose an OfficeNormanMustangSouth OKCHow Did You Hear About Us?*Web SearchReferral From a Friend / FamilyReferral from a DentistCommunity EventSocial MediaOtherWho Referred You?Name of Your DentistWho is Your Insurance Provider?Have you worn braces or invisible aligners in the past?YesNoWhat treatment would you like?Limited Treatment (Braces or Invisalign, minor corrections only)Comprehensive Treatment (Braces or Invisalign, complete alignment of all teeth and bite correction)Of the images below, which one best describes your teeth crowding?*mild, or no crowdingmoderateextremeOf the images below, which one best describes your teeth spacing?*mild, or no extra spacemoderateextremeAre you 18 or older?YesNo Subscribe to our newsletter
