Free Smile Assessment for New Patients "*" indicates required fields Step 1 of 10 10% Interested in learning about obtaining a beautiful and healthy new smile before coming to our office? Start your smile journey with CHT Orthodontics, an expert orthodontic practice that understands your busy lifestyle. Start by telling us a little about yourself. Then, you'll snap a few pictures of your teeth and Dr. Carrie will be in touch regarding your treatment options!Patient Name* First Last Email* Phone*Birthdate* Month Day Year Age* What concerns you about your smile?* Smile Esthetics Crowding Shifting Spacing Overbite (the upper front teeth appear to stick out over the lower teeth) Underbite (the lower teeth may appear too far forward, while the upper teeth are set too far back) Other Upload pictures of your smile from the angles below: Facing the camera, lips together & relaxed* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. Upload pictures of your smile from the angles below: Facing the camera smiling* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 5 MB, Max. files: 1. Upload pictures of your smile from the angles below: Turned toward the left, lips together & relaxed* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. Upload pictures of your smile from the angles below: Frontal view biting down* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. Upload pictures of your smile from the angles below: Right side view* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. Upload pictures of your smile from the angles below: Left side view* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. Upload pictures of your smile from the angles below: Upper view* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. Upload pictures of your smile from the angles below: Lower view* Drop files here or Select files Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 1. NameThis field is for validation purposes and should be left unchanged. Δ
