Virtual Orthodontic Exam

Would you like to find out if you or your child are ready for orthodontic treatment with Invisalign or Braces?
At Abraham Orthodontics, we offer a FREE “virtual” orthodontic smile exam so you can find out:

1. Is it the right time for treatment? If yes, when can you schedule a complimentary full exam?
2. How much does treatment cost and what are the payment options?

From there, a complimentary in-office exam would be scheduled to be completed.

Fill out the form below and take 5 Pictures of Your teeth:

We will contact you to discuss your options!

Date (mm-dd-yyyy)*


PATIENT INFORMATION

Your Name *
Last Name *
Email *
Telephone (Guardian telephone if under 18)
Date of Birth (mm-dd-yyyy)*
Patient's Guardian

Guardian's Email
Relationship


Main Orthodontic Concern:

Are you undergoing active dental treatment? NoYes

Have you seen another orthodontist before? NoYes

Photos Upload (See the sample above)

Top surface of upper teeth
Top surface of lower teeth
Frontal Smiling
Left Smiling
Right Smile