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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!

    #1 Lower Teeth*
    lower-teeth
    #2 Upper Teeth*
    top teeth
    #3 Front View, smiling*
    Front Teeth
    #4 Right View*
    Right teeth
    #5 Left View*
    left teeth

    *maximum upload file size 4MB Each





    BracesInvisalign


    YesNo



    mild, or no crowdingmoderateextreme


    mild, or no extra spacemoderateextreme