Virtual Smile Consultation Welcome:Your time is important! We realize you want to know what it will take to improve your smile and your health, without having to take the time to come in for an official appointment.To save you time, we’ve set up this opportunity for a virtual exam.All we need are some pictures of your teeth / smile and an idea of what you’re hoping to see corrected.You can complete this free consultation from the convenience of your home using your computer or your phone!Lets get started! Disclaimer: By completing this free consultation, you authorize us to contact you with your results. We value your privacy and will not share your info with others. Your virtual evaluation is provided as a free service to help you learn how Chmura Orthodontics can help you correct any oral concerns. This virtual evaluation is not meant to replace a full evaluation. Note that your request will be sent to Chmura Orthodontics via email. Chmura Orthodontics is not responsible for any data charges that may occur using the virtual evaluation. Your Info:Your Name *Email Address *Your Phone #Date of BirthHow to Photograph your Smile:Items you will need: 2 spoons to hold your cheeks out of the way Someone to help take your photos (recommended)* *Tip: If no one is available to help, set your phone photo timer (for photos you can't take with only one hand). Recommendations for best photo results: Photos should be taken in a seated position Use flash on camera to help light teeth and mouth Selfie PhotoSelfie Photo: Please take a selfie photo showing your entire face. Be sure to smile for your selfie photo.😁 Upload Photo #1 - Selfie Photo *Choose FileNo file chosenDelete uploaded fileFront Photos:#2 - Front Biting: Bite down on your back teeth. Pull both cheeks back as far and wide as you can to show as much your teeth and gums as possible. Snap photo directly in front of your mouth. #3 - Front Open: Pull both cheeks back as far and wide as you can to show as much your teeth and gums as possible. Open your mouth just a little to add space between upper and lower teeth. Snap photo directly in front of your mouth. Upload Photo #2 - Front Biting *Choose FileNo file chosenDelete uploaded fileUpload Photo #3 - Front Open *Choose FileNo file chosenDelete uploaded fileRight & Left Photos:#4 - Right Bite: Bite down on your back teeth. Use the spoon to pull back your right cheek as far as you can. Snap photo directly at the right side of your mouth. #5 - Left Bite: Bite down on your back teeth. Use the spoon to pull back your left cheek as far as you can.. Snap photo directly at the left side of your mouth. Upload Photo #4 - Right Bite *Choose FileNo file chosenDelete uploaded fileUpload Photo #5 - Left Bite *Choose FileNo file chosenDelete uploaded fileUpper & Lower Photos:#6 - Upper Teeth: Tip your head back. Snap photo of your upper teeth. Use spoons (if needed) to hold your cheeks out of the way. #7 - Lower Teeth: Tip your head down. Snap photo of your lower teeth. Use spoons (if needed) to hold your cheeks out of the way. Upload Photo #6 - Upper Teeth *Choose FileNo file chosenDelete uploaded fileUpload Photo #7 - Lower Teeth *Choose FileNo file chosenDelete uploaded fileAbout My Smile: What I love about my smile0 / 650What I dislike about my smile0 / 650Additional Comments0 / 650Ready To Send?When you are ready, please click the 'send consultation' button to send us your virtual smile consultation. Once we receive your virtual consultation, we will work to review your info and photos and will contact you as soon as possible for your results! We are excited for you to start down the journey to a new confident smile! If you have any questions or additional comments, please feel free to contact us using this Contact Us Form or you can give us a call at (269) 781-4000. Send My Smile!