Smile Consultation Form

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Hi, Congrats! on your smile makeover journey, below I've laid out some details on what to expect from your consultation. Please watch full video before proceeding! Lets begin "Press Play"
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Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
Area Code
Phone Number
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Email* This field is required.
example@example.com
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Are you reaching out about our limited special promotion?* This field is required.
YESNO
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All discounts and offers are only valid during your consultation call. Client managers cannot hold deals or secure dates without a deposit.* This field is required.
I agree! Im ready
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What would you like to change about your smile?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Available dates and times are listed below please select and date and time for your smile consultation from the list of available selections.* This field is required.
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Leadership Discounts - $1,000 Discount

The United States Military

All Health Care Workers

Public Servants - Government and Civil

Fire Fighters - Emergency Responders

Teachers and Educators

Social Workers and Counselors

Mental Health Professionals

Humanitarian and Aid Workers

Community Organizers and Activist

Scientist and Researchers

Environmentalist and Conservationists

Engineers and Technologists

Non Profit Organization Workers

Clean Energy Specialist

Architects and Urban Planners

Farmers and Agricultural Workers

Truck Drivers

Civil Rights Lawyers

Journalist and Media Professionals

Certified Motivational Coach

Pilots and Flight Attendants

Airline Workers

All Local City Workers

Divine 9 Members

HBCU Alumni
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I qualify for the leadership discount Claim $1,000 Discount - Proof Required
Please Select
Please Select
United States Military
Health Care Workers
Public Servants - Government and Civil
Fire Fighters - Emergency Responders
Teachers and Educators
Social Workers and Counselors
Mental Health Professionals
Humanitarian and Aid Workers
Community Organizers and Activist
Scientist and Researchers
Environmentalist and Conservationists
Engineers and Technologists
Non Profit Organization Workers
Clean Energy Specialist
Architects and Urban Planners
Farmers and Agricultural Workers
Truck Drivers
Civil Rights Lawyers
Journalist and Media Professionals
Certified Motivational Coach
Pilots and Flight Attendants
Airline Workers
All Local City Workers
Divine 9 Members
HBCU Alumni
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Important Notice: Please carefully read the following information before proceeding

Disclaimer: The demand for zirconia and porcelain veneers smile makeovers here at Forever Veneers Houston has been exceptionally high. We are currently scheduling clients for calendar dates in 2025-2026. To accommodate as many individuals as possible, we can only accept deposits for appointment date’s within the next 3 months. For appointments beyond this timeframe, full payment will be required to secure promotional pricing. If you plan to start your smile makeover journey after the 3-month window and cannot secure a spot using the full payment option, we kindly request that you submit your smile design consultation form closer to your intended timeframe. This allows us to prioritize clients who are ready to proceed within the next 3-6 calendar months.

At this time, we are unable to accommodate consultation research phase calls for individuals considering veneers 7+ months into the future. However, as stated above, to secure a spot and take advantage of any specials or promotional prices, we do offer deposit options which will be listed below in this form.We appreciate your consideration of others who are ready to proceed and ask that you reach out closer to your desired date of scheduling, as our available spaces are limited. We genuinely appreciate your understanding and cooperation during this time.
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I have read the disclaimer and I am ready to move forward with scheduling my consultation* This field is required.
Yes
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What is your gender* This field is required.
Male
Female
Non-Binary
Prefer not to answer
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City & State* This field is required.
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Please provide your age* This field is required.
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Date of birth?* This field is required.
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Please provide your social media page name* This field is required.
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Is this your first smile consultation* This field is required.
YESNO
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How many smile consultations have you had* This field is required.
0
1-2
3-6
Over 6+
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How will you be paying for your smile makeover?* This field is required.Select all that apply
Cash- Save $500
Certified Check - Save $500
Credit Card - Live Notary
Financing
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What is your smile design budget?* This field is required.Select all that apply
$10,000
$15,000
$25,000
$35,000
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Deposit Options* This field is required.Deposits are used to provide additional time to clients who would like to take advantage of our promotional rates today, all deposits are applied to the total price of your porcelain veneer installation. Deposits amounts are based on time needed by the client to complete full payment.
Cash Deposit
Cashapp Deposit
Zelle Deposit
Apple Pay Deposit
Credit Card Deposit
Financing
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I understand that deposit or full payment will be required to hold promotional rates * This field is required.
YESNO
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Please check all that apply* This field is required.
I currently have composites
I have crowns
I have implants
I have caps
I have permanent gold teeth
I have a bridge installed
I have dentures or partials
I have all on 4
I have veneers
I have missing teeth
I have porcelain crowns
I have metal crowns / porcelain fused metal
I have zirconia crowns
I have an underbite
I have an overbite
I have a gummy smile
I have cavities
I need a professional cleaning
I have teeth grinding
None of the above
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Please check all that apply* This field is required.
I need implant/s
I need all on 4's
I need crown/s
I need bridge/s
I need cavity repair
I need a root canal
I need extractions
I need gum contouring
I need a deep cleaning
I need a full dental evaluation
I need the strongest material you have
None of the above
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How soon are you looking to transform your smile?* This field is required.Due to high demand we can currently only accommodate clients that are ready to obtain smile makeovers in the 2 week to 4 month time period, for longer times ranging 4+ months into the future we ask that you submit your smile consultation form closer to your desired veneer installation date.
Within the next 2 weeks - Deposit Required
In the next month - Deposit Required
2 months - Deposit Required
3 months - Deposit Required
4-6 months - Deposit Required
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When was your last cleaning?* This field is required.
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How did you hear about Forever Veneers* This field is required.
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What shade are you most interested in?* This field is required.
Hollywood White - Premium
Natural Shades
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We provide celebrity / smile design customization options would you like to customize the design of your smile?* This field is required.
Yes, I want to customize my smile
No, let the lab choose for me
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Forever Veneers now offers a yearly insurance plan to protect your smile makeover investment. This plan covers all 20 porcelain veneers in the event a client cracks or breaks any of their veneers. Would you be interested in protecting your investment?* This field is required.
YESNO
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Upload Photos

Please be upload clear photographs of your full face with a big smile, and also upload pictures of your smile in mutple angles that will be listed on the upload screen, . All photographs are confidential and will not be shared. If for any reason you have difficulty submitting your online consultation here, please email the photos of your teeth to support@foreverveneers.com

Please make sure that your camera is clean when taking pictures of your teeth and refrain from using filters and altering camera effects

Photo Tips:

Use bright lighting—natural daylight works best

Keep the camera still and focused

You can use your front camera or have someone help you with the photos

Try to keep each photo sharp and clear for the best results

Important: To increase your chances of approval, please move to the next section to upload your photos and follow the directions carefully.
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1. Take a photo of your full face while smiling naturally.* This field is required.Look straight at the camera, relax your face, and give a natural smile. Make sure your entire face is in the frame.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Position your top row of teeth over your bottom row of teeth - (Your Natural Smile Position) We need to see your top and bottom teeth togetherPlease upload your photo on the next page
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Image Field
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2.Take a close up photo of your biggest smile with your teeth together.* This field is required.Position your top row of teeth over your bottom row of teeth - (Your Natural Smile Position) We need to see your top and bottom teeth together
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Image Field
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3. Take a photo of the left side of your teeth while smiling with your teeth together.* This field is required.Use your fingers to gently pull your right cheek back. Keep your teeth closed and smile big. Take the photo from the left side so we can see how your back teeth line up.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Image Field
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4. Take a photo of the right side of your teeth while smiling with your teeth together.* This field is required.Pull your left cheek back the same way. Keep your teeth together and take the photo from the right side.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Image Field
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5. Take a photo of the top teeth and roof of your mouth.* This field is required.Tilt your head back and open wide. Take a photo that clearly shows your upper teeth and the roof of your mouth. Use good lighting if needed.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Image Field
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6. Take a photo of your bottom teeth from above.* This field is required.Tilt your head down and open your mouth wide. Take the photo so we can see all of your bottom teeth from the top view.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Fraud Identity Theft Disclaimer:

We take fraud identity / theft seriously. Our stringent security measures are designed to prevent and deter fraudulent activities. If you are considering engaging in such actions, be aware that we will not tolerate any form of identity theft, impersonation, or unauthorized use of personal information.

Our advanced security protocols, including encryption and verification procedures, are in place to safeguard our customers' personal information and we urge you to think twice before attempting any fraudulent activity to obtain a new smile makeover. Our systems are designed to detect and prevent such acts, and we reserve the right to refuse service.

Your cooperation in maintaining a safe and secure environment is greatly appreciated.

Note: If you choose financing as an option (CPN Numbers) will be detected and will not be allowed to secure financing contracts with any of our partner providers.
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Fraud Identity Theft Disclaimer:* This field is required.
I AGREE
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Any discounts or special offers discussed during your consultation call are valid only at that time. Client managers are unable to hold deals or secure dates without a deposit. We encourage you to take advantage of the offers presented during your consultation for best pricing.* This field is required.
Please Type ' OK in the box
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Any discounts or special offers discussed during your consultation call are valid only at that time. Client managers are unable to hold deals or secure dates without a deposit. We encourage you to take advantage of the offers presented during your consultation for best pricing.* This field is required.
I am ready to Start
Lets Do It
Im In It To Win It!
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I am using my own personal information to submit this form or submitting information on behalf of someone I am authorized to represent . Please type YES * This field is required.
Type yes in the box to confirm
Should be Empty: