Lets Get Started!

Info about the patient

Choose your options

5 quick teeth selfies

Are you a New patient or a Current patient? *

New Patient

Existing Patient

How did you hear about us?

How would you prefer your virtual consultation? *

Facetime (iphone users only)

ZOOM via phone

ZOOM via email address

Patient & Contact Information

Safe. Secure. Won’t Share.

Where should we email your treatment plan? *

What is the best phone number to reach you? *

What is the patient's name? *

What is the patient's age? *

What is the patient's postal code? *

We Want to Make You Smile!

Tell us how we can help

Which type of orthodontic treatment are you most interested in? *

Metal braces

Clear Braces

Invisalign

My dentist mentioned my child may need an expander

What matters most to you about your orthodontic treatment plan?

Length of Treatment

Will there be any discomfort?

Nothing, just excited to get started

Your primary concern *

Almost Done

On the next screen, we’ll take 5 pics

width=”259″ height=”118″

width=”234″ height=”190″

This allows us to customize your treatment plan. Here’s a quick video to help take perfect pics.

Smile and Shoot

Now, just snap a few photos so Dr. Mongiovi can evaluate the position of your teeth and bite.

First, wash your hands, or you can use spoons.

Center *

Right *

Left *

Upper *

Lower *

Thank you for your submission!

As a thank you, we will give you a $300 credit* towards orthodontic treatment with completion of your virtual visit.

* Certain restrictions apply

CHECK OUT OUR MUSIC VIDEO ON YOUTUBE!

For New Patients

Contact & Hours

Office Hours