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  • APPLY TO BE A PATIENT

  • Please take your time completing this 3-part application. 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 health practices.
    • Dental Imagery/Previous Records: Give us an idea of your current oral health! Using a smartphone, a friend, and good lighting, capture the following images (examples and descriptions provided). Additionally, Dr. Kriegel requires your most current panoramic x-ray (available from your current dental office). This image must be uploaded to complete the application. Please reach out to our office if you have any questions. 
    • Bonus Video: Record a video telling us why you want to be a patient at Vios.

  • Your Basic Information

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

  • Your Medical and Dental Information

  • Date of last dental visit*
     - -
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  • 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?*

  • Your Medical and Dental Information

  • 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)?*
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  • 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
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  • 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.

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