Teacher Appreciation - Free Treatment Submission
Teachers, we want to thank you for everything that you do for our community, and for all of the positive impact that you have on young, bright futures. As a thank you, we want to offer a full braces or clear aligners treatment, completely free of charge. We will need you to fill out this form, and complete a virtual consultation to ensure that you are a candidate for orthodontic treatment with Andrews Braces. Thank you in advance for your time, and good luck!
Name
*
First Name
Last Name
What school do you teach at?
*
What subject(s) do you teach?
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you willing to be shown on social media throughout your treatment?
*
Yes
No
Have you seen a dentist in the last year?
*
Yes
No
Who is your dentist?
*
May we contact your dentist to obtain dental records?
*
Yes
No
I hereby declare all of the information above to be true, that I am a teacher in the Washoe County School District, and I understand that I may not be chosen for free treatment if I am not a candidate for orthodontic treatment.
Please verify that you are human
*
Submit
Submit
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