FREE SMILE ASSESSMENT

With a FREE SMILE ASSESSMENT, one of our doctors will look at photos you submit of your teeth and we can give you an idea of what treatment they recommend and give you a cost estimate!

Follow the steps below for your free smile assessment:

Send New Patient Forms and copy of Dental Insurance card if applicable (this helps us verify any insurance benefit you may have).
Follow our examples below to submit photos for the doctors to analyze.
We will get back to you on recommended treatment, cost estimations and what’s next!

STEP 1: Complete new patient form

(save PDF to desktop, fill out form, and then save form)

STEP 2: Click here to send new patient forms, copy of dental insurance card, and submit photos (examples below)

or e-mail to info@glanderrochfordorthodontics.com

Include patient’s name and birthdate in the email

Three Quick Facial Photos

Facial photos should be taken with your back against a plain wall and your phone camera flash on. They should be from shoulders up as shown below

Facing the camera, lips together & relaxed

Turned toward the left, lips together & relaxed

Five Quick Teeth Selfies

All you need to capture these photos is a cell phone and a pair of spoons. The spoons will be used to keep cheeks and lips out of the way so that we can get better views of your teeth. For clearer, brighter photos please make sure your flash is on and the photos are focused. Below are examples of what the photos should look like.