Photo Upload Form

Photo Upload Form
Thank you for choosing a virtual smile assessment! Below you will find instructions for submitting photos to be evaluated by our team.
- If you are a New Patient , be sure to provide detailed information on your concerns about your smile in the comment section below.
- If you are a Current Patient , simply upload your photos and you will recieve treatment notes with Dr. Schnepper's recommendations.
Photo Instructions

Bite down on your back teeth and smile as wide as you can! Pull your lips and cheeks back either with your finger or using a spoon for a better view.

Take photos using the flash setting on your phone and do your best to match the pictures below.
Which of these describes you?

I am a new patient requesting a virtual smile assessment I am a current patient submitting progress photos
Patient Name *

First Name Last Name
Birth Date *

Month Day Year
Phone Number *

Area Code Phone Number
E-mail *
Best Way to Contact You (select all that apply):

Call Email Text
Upload Photos *

Browse Files

Cancel of
What would you like Dr. Schnepper to know about your smile?
Should be Empty: