Virtual Smile Assessment - Orthodontics
Send us some photos for an Orthodontic Smile Assessment
This page works best on your mobile device. If you are on your computer, open your phone or tablet's camera and scan the below QR code:
From your mobile device, upload a few photos, which Let's Smile Dental will review. We'll then put together a custom treatment plan explaining all of your options - including pricing and treatment time.
Are You A New Patient?
*
Yes
No
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Photo #1
Smile wide! Pull back your cheeks with a finger on each side to snap this shot (you may need a friend to take the picture). And remember to take the picture straight on.
Click to take Smile Picture
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo #2
Pull your left cheek so we can see your side teeth. Bite your back teeth tight together for the photo.
Click to take Left Picture
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo #3
Pull your right cheek toward your ear so we can see your side teeth. Bite your back teeth tight together for the photo.
Click to take Right Picture
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo #4
Tip head back and open really wide. Use one hand to keep your upper lip out of the way.
Click to take Upper Picture
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Browse Files
Drag and drop files here
Choose a file
Cancel
of
Photo #5
Tip head down and open really wide. Use one hand to keep your lower lip out of the way.
Click to take Lower Picture
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
If feasible, which would you prefer?
*
Invisalign® Clear Aligners
Clear Braces
Metal Braces
Tell us what concerns you the most?
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Which of our locations is closest to you? (optional)
Fairfax
Reston
Springfield
Centreville
Fredericksburg
Alexandria
Purcellville
Herndon
In order to help us provide you with the most accurate fee for your customized treatment, please snap two quick photos of your insurance card and we will look into your coverage and benefits.
*Not required.
Front of Insurance Card (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Front of Insurance Card (optional)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Patient's Birth Date (optional)
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Month
-
Day
Year
Date
Insurance Holder's Birth Date (optional)
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Month
-
Day
Year
Date
Promo Code for $250 Off Orthodontic Treatment (optional)
Submit
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