• Vios Integrative Dentistry Logo

  • APPLY TO BE A PATIENT

  • Please take your time completing this application—we review every submission thoroughly and thoughtfully.

    What this process includes:

    Health History & Patient Questionnaire
    Complete our short health history form and share more about your dental journey. This helps us understand your goals, lifestyle, and overall health so we can approach your care comprehensively.

    Dental Imagery & Previous Records
    Give us a clear picture of your current oral health. Using a smartphone, a friend, and good lighting, capture the requested images (examples and instructions are provided).

    Dr. Kriegel requires your most recent panoramic x-ray from your current dental office, and this is needed to complete your application. If you’re still in the process of obtaining it, you may upload a placeholder image and note this in the “Any Additional Information” section—we’ll follow up with you from there.
     
     

  • Your Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • Your Medical and Dental Information

  • Date of last dental visit*
     - -
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Why are you reaching out to Vios Dental? (select all that apply)*
  • What’s most important to you in your dental care?*
  • What concerns do you have about dental treatment?*
  • Have you ever had orthodontic (braces) treatment?*
  • Do you get headaches?*
  • How frequent are your headaches?*
  • Do you have any clicking, popping, or discomfort in your jaw?*
  • Do you experience ear pain?*
  • Do you have a history of tinnitus?*
  • Do you grind or clench your teeth?*
  • Do you follow any specific diet or way of eating?*
  • Are you currently working with any alternative healthcare providers (ie chiropractors, acupuncturists, naturopaths, functional medicine doctors, etc.)?*
  • Are you being treated for any chronic diseases?*
  • Have you been diagnosed with autoimmune disease?*
  • Have you experienced any issues with snoring, waking up feeling tired, or pauses in your breathing during sleep (sleep apnea)?*
  • Are you taking any prescription, over-the-counter medicines, or supplements? Upload a photo or list below.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Everyone processes information differently—what feels most like you?

  • Your Dental Images

    Please see below for the images required. Click the image below to watch the how to video: https://www.youtube.com/watch?v=iBIS6VV3S_8
  • A thumbnail image for a video on how to take dental imagery that is part of this applicaiton process

    1. FULL FACE - A full face shot with natural smile

    2. NATURAL SMILE AT REST - A natural expression at rest

    3. BIG SMILE - A “cheesy” smile

    4. OPEN SMILE - A retracted smile, teeth slightly apart

    5. RETRACTED RIGHT SIDE - A retracted right side profile

    6. RETRACTED LEFT SIDE - A retracted left side profile

    7. UPPER ARCH - A retracted upper arch

    8. LOWER ARCH - A retracted lower arch

  • Example images of the dental images that need to be uploaded as part of this application
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • When in doubt, capture the image further away than too close as the focus tends to blur when too close. All images should be taken with help for ease and quality.

  • Should be Empty: