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    Patient Info


    Upload Photos

    If you can submit your photos, that will help us determine your treatment plan before your visit! Photos are optional but recommended 🙂

    #1 Lower Teeth*
    #2 Upper Teeth*
    #3 Front View, smiling*
    #4 Right View*
    #5 Left View*

    *maximum upload file size 5MB Each



    Clear alignersBraces

    YesNo


    mild, or no crowdingmoderateextreme


    mild, or no extra spacemoderateextreme