Schedule In-Person Consultation Online

Patients Full Name *

Phone *

Insurance Information

Do you have dental insurance? This allows us to verify any orthodontic benefits. *

Yes (Private Insurance)

No (Self Pay)

Please note: We do not accept state insurance. If you have state insurance and would still like to schedule a consultation, please select the self-pay option above to continue.

Upload Dental Insurance Card

Front Of Insurance Card

Back Of Insurance Card

Primary Insured Name *

Primary Insured Birthday *

Primary Insured Relationship to Patient (Select One) *

Primary Insured Employer *

Dental Insurance Company Name & State *

Group Number *

Policy Number *

You're ready to schedule your in-person consultation!

Please click "Submit" to be directed to our online scheduler.