Virtual Smile Consult — Alexandria Orthodontics

Your Information

So we know who you are and how to reach you.

First Name *

Last Name *

Email *

Mobile Phone *

Year of Birth *

Zip Code *

Your Photos *

All six shots are required. Watch the quick how-to, then add each photo below.

Start here

Watch: How to take your photos

A quick guide to getting all six shots right.

All 6 photos are required. JPG or PNG work best. iPhone HEIC photos are usually fine; if a photo shows an error, retake it or switch your camera to "Most Compatible." Max 70 MB per photo.

A Few Questions

Tell us what you are looking for so we can tailor your consult.

Why are you seeking orthodontic treatment? * (select all that apply)

I want to straighten my teeth I have a special occasion coming up Crowding or spacing concerns Bite or jaw issues General evaluation Other (write below)

Describe your orthodontic goals or objectives *

Which treatment method do you prefer? *

Braces

Invisalign Clear Aligners

Either is fine

Whatever the doctor recommends, not sure yet

How soon would you like to begin? *

I'm ready, ASAP

1–3 months

3–6 months

Flexible

Are you up to date with cleanings with a dentist? *

Yes

Not sure

Other

What matters most to you? * (1 = least, 5 = most)

Quality of care

Affordability

Time & total visits

Insurance

Optional. Only a couple of quick details if you have coverage.

Do you have dental insurance with an orthodontic benefit?

Yes No

Would you like us to verify your insurance benefit?

Yes No

Insurance Subscriber

Insurance Provider

Member ID Number

Member's Birth Year

Review & Submit

Tap "Review my answers" to see a summary, then confirm to submit.

Check your details above, then confirm to submit.

Thank you!

Your virtual consult has been submitted. Our team at Alexandria Orthodontics will review your photos and reach out with your next steps soon.