Virtual Smile Assessment

1
When I look at my smile, my teeth resemble:
A crowded photo - smushed together
A picket fence - straight with gaps
A shelf of books - some tilted
Curtains - one big gap
One snaggletooth that sticks out
Something else - you'll see!
2
Have you tried to straighten your teeth before?
I've had braces
I've tried a DIY kit
I had Invisalign® but stopped wearing it
No, and it's finally time!
3
What's your age range?
Under age 15
Age 15-24
Age 25-40
I'm over 40
4
Besides alignment, is there anything else we should look at for you when you upload your smile photo?
Could my teeth be whiter?
Do my gums look healthy? They sometimes bleed or are sore.
I have a chipped tooth. Can it be fixed?
Other
5
Image FieldFirst, take a photo that clearly shows us your teeth from the front, in an open-mouthed smile. Think of baring your teeth like a tiger! Click "Next" when you're ready to upload your photo.
6
Front Photos:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
7
Image FieldNext, take a photo that clearly shows us your teeth from one side. Pull that cheek back! Click "Next" when you're ready to upload your photo.
8
Side 1 Photos:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
9
Image FieldAnd now the other side, please! Click "Next" when you're ready to upload your photo.
10
Side 2 Photos:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
11
Image FieldLast step: the inside top and bottom! Let's start with the upper row, like this. Click "Next" when you're ready to upload your photo.
12
Inside Upper Photos:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
13
Image FieldAnd now the bottom row! Click "Next" when you're ready to upload your photo.
14
Inside Lower Photos:
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
15
Perfect! Please tell us your full name:* This field is required.
First Name
Last Name
16
Where can we email your results?* This field is required.We'll never sell or share your email.
example@example.com
17
Before You Submit:* This field is required.By checking "I agree" below, I agree to send my photos and information via this form, which sends an email and also stores my submission in a survey tool. I understand that a virtual exam and smile assessment is not always an exact diagnosis, and additional records or appointments may be required. HIPAA (Health Insurance Portability and Accountability Act) was passed by the U.S. government in 1996 to establish privacy and security protections for health information. Information stored on our computers is encrypted, but most popular email services and web-based form collectors are not encrypted. A third party may be able to access the information, and once an email is received by you, someone may access your email account and read it. By sending a request through this form, which sends us an email, you are accepting the terms and conditions of sending non-encrypted information.
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