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Our Process
Pricing
About Us
Smile Studio
Free Assessment
Free Assessment
Basic Info
Let us take some basic info about your teeth.
1
Have you worn braces or aligners in the past?
*
Yes
No
2
Is the patient over the age of 14?
*
Yes
No
3
What is the biggest problem you want to address?
*
Gapped Teeth
I have gaps in my teeth that need to be closed.
Crowded Teeth
My teeth are crowded together and have no room to fit normally.
General
Just make em' look pretty!
4
Choose the picture below that best describes your teeth crowding:
*
None or Mild
Moderate
Severe
5
Choose the picture below that best describes your teeth spacing:
*
None or Mild
Moderate
Severe
6
Please attach pictures of your teeth: (Optional)
We want to take a clear view of your smile: Front-On, Right Side, Left Side, Open Down, Open Up, Mouth Clinched
Contact Details
Full Name
*
Email
*
Phone
*
Postal Code
*
Best Time To Call
*
Morning
Afternoon
Evening
I agree to the Straight My Teeth
privacy policy
,
terms of use
and to receiving marketing communications & text messeage.
All fields are required.
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