Virtual Smile Assessment

FREE Virtual Smile Assessment

919-380-9922 NAYortho.com
Find out if you are a candidate for orthodontic treatment before walking through our door!

At NAY orthodontics, we offer a virtual consultation for our patients. Simply snap some teeth selfies and send to us for a free Smile Assessment.
First Name*
Last Name*
Phone Number*

Area CodePhone Number
E-mail*
What concerns do you have about your smile?*
Example- Overbite, Alignment, etc
Are you a New Patient of NAY orthodontics?*
Patient Date of Birth*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have dental insurance? *
Insured Name

First NameLast Name
Relationship to Patient
Insured Date of Birth

MonthDayYear
Insurance Provider Name
Signature*

Clear
NAY orthodontics is authorized to release protected health information about the above named patient to the entities named as Responsible Party, Legal Parent or Guardian.

HOW TO PHOTOGRAPH YOUR SMILE:

Photos should be taken in a room with good lighting, against a white wall if possible. For best results, have someone else take the photos, as they can be difficult to take on your own. Do the best you can, and know that we will take complete records at your in-office visit.

Here’s what you’ll need to take your series of 5 photos:
- 2 spoons
- 1 camera
- 1 partner
HERE ARE A FEW TIPS TO CAPTURE THE PERFECT TOOTH PICS:
- Take photos with the flash on and get as close as you can to take clear photos.
- Use teaspoons to retract your lips for the photos of your teeth (2 for the center shot, and 1 for the right and left views of your bite).
- Bite on your back molars when taking the photos of your bite.
- If you are taking the photos yourself - use selfie mode, and rotate the phone around so the camera is pointing inside your mouth for the photo of your top teeth. This makes it easier to get a better angle.
- Don’t worry about cropping the photos to match ours perfectly. We will take care of that!
Front Smile Photo -

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Left Side Photo -

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Right Side Photo -

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Upper Teeth Photo -

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Lower Teeth Photo -

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