Book Your Virtual Consultation

Skip a trip to the office and connect with us from wherever you are. Simply fill out the form below and snap a few photos. Once Dr. Kothari reviews your information, we’ll reach out via phone or email to discuss your personalized treatment recommendations.

virtual-orthodontic-consultation

    Patient Info


    Upload Photos

    If you can submit your photos, that will help us determine your treatment plan before your visit! When taking pictures, please use flash.

    #1 Lower Teeth*
    lower-teeth
    #2 Upper Teeth*
    top teeth
    #3 Front View*
    Front Teeth
    #4 Right View*
    Right teeth
    #5 Left View*
    left teeth

    *maximum upload file size 4MB Each





    Limited Treatment (Braces or Clear Aligners, minor corrections only)Comprehensive Treatment (Braces or Clear Aligners, complete alignment of all teeth and bite correction)


    YesNo



    mild, or no crowdingmoderateextreme


    mild, or no extra spacemoderateextreme