Complete Your Virtual Consultation from Home Today!*

Have you ever wondered if you or your child could benefit from orthodontic treatment? We’re making the process easier than ever by offering virtual consultations. That’s right! You can get started from the comfort of your own home. You don’t even need to get changed out of your pajamas.

You’ll simply answer a few questions on our form and snap some photos of your smile. Our Park Slope orthodontist will then customize the best treatment plan for you or your child. We’ll be in touch to discuss the details, including our treatments recommendations and our affordable payment options. Let’s get started!

* Virtual consultations are reserved for patients ages 13 and up. For younger patients with baby teeth, an in-person consultation will be more effective.

Schedule a Virtual Consultation!

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Patient Info

Name*

First Last

Your Email*

Phone*

Age*

Preferred Method of Communication

Additional Information:

Upload Photos

If you can submit your photos, that will help us determine your treatment plan before your visit!

#1 Lower Teeth lower-teeth

Open your mouth wide and tilt your chin downwards toward your chest. Hold the camera so it’s perpendicular to the biting surfaces of your bottom teeth. Make sure your full arch is showing and then snap a picture.

#2 Upper Teeth

Open your mouth wide and lift your chin as high as you can. Hold the camera so that it’s perpendicular to the biting surfaces of your top teeth. Make sure you can see the full arch and then click.

#3 Front View, smiling Front Teeth

Bite down so your back teeth touch. Directly facing the camera, smile wide and click, trying to get as many teeth as you can in the picture. If you need to, you can pull your lips and cheeks away from your teeth with spoons to show more teeth.

#4 Right View Right teeth

Bite down so that your back teeth touch, smile and retract the cheek and lips with a spoon pulling on the right side of your mouth to expose more of your teeth. Take a picture of the right side.

#5 Left View left teeth

Bite down so that your back teeth touch, smile and retract the cheek and lips with a spoon pulling on the left side of your mouth to expose more of your teeth. Take a picture of the left side.

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Who Referred You?

Name of Your Dentist

Who is Your Insurance Provider?

What treatment would you like?

Limited Treatment (Braces or Invisalign, minor corrections only)

Comprehensive Treatment (Braces or Invisalign, complete alignment of all teeth and bite correction)

Have you worn braces or invisible aligners in the past?

Yes

Choose the option that best describes your biggest concern with your smile:

Fix a spacing issue

Fix a crowding issue

Fix a bite problem (overbite, underbite or crossbite)

Generally Straighter Teeth

I agree to allow Fresh Orthodontics to contact me through text messages (e.g., appointment reminders, follow-up information)

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Complete Your Virtual Consultation from Home Today!*

Schedule a Virtual Consultation!

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