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.

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