NP Consult Photo Upload

Virtual Appointment
Thank you for choosing a virtual smile assessment! Below you will find instructions for submitting photos to be evaluated by our team.
- Be sure to provide detailed information on your concerns about your smile in the comment section below.
- You can upload as many photos as you want (especially if you have a specific concern you would like us to review)
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.
Photos are an example of what we take here in the office. Try to replicate the photos shown to the best of your ability.
Which of these describes you?

I am a new patient requesting a virtual smile assessment I am a previous patient with questions about changes to my bite and smile since ending treatment
Patient Name *

First Name Last Name
Birth Date *

Month Day Year
Phone Number *

Area Code Phone Number
E-mail *
Please list your general dentist
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?
If you have dental insurance, please provide the following information
Insurance name:
Policy Holder (Subscriber)
Policy Holder's Date of Birth:

Month Day Year
Date
Member ID:
Group Number:
Employer:
If you have multiple insurance plans, please provide the same information asked above for any additional plans
Should be Empty:

Virtual Appointment