New Patient Virtual Exam Get Started with 4 quick steps! Smile Concerns Interests Upload photos Patient info Step 1 of 10 - Smile Concerns 0% What are your concerns?*(Choose any that apply.) Overbite / Underbite Crooked / crowded Spacing / gaps Others What's the concern/issue Which treatment modality are you interested in?*(Choose any that apply.) Metal braces Clear braces Invisalign for kids Invisalign for teens / adults Have you ever had orthodontic treatment?*YesNoIf so, was it with White, Greer, & Maggard?*YesNo Patient Information Dr. Cliff Lowdenback will be reviewing your photos and concerns. We'll be in touch shortly!Patient's Full Name*Your name, if not the patientPatient's Date of Birth Date Format: MM slash DD slash YYYY Preferred office locationLexington - BeaumontLexington - HamburgLexington - Wellington WayLexington - AlumniLouisville - OuterloopLouisville - TaylorsvilleCorbinCynthianaDanvilleGeorgetownLondonMoreheadMt. SterlingNicholasvilleParisRichmondShepherdsvilleWinchesterPhone*If patient is a minor, please ensure parent/guardian is present for virtual examEmail Preferred contact methodTextCallEmailWould you like to upload photos for our doctors to review?*YesNo Front Smiling Upload ImageAccepted file types: jpg, png, gif, pdf, jpeg. Front Upload ImageAccepted file types: jpg, png, gif, pdf, jpeg. Right Bite Upload ImageAccepted file types: jpg, png, gif, pdf, jpeg. Left Bite Upload ImageAccepted file types: jpg, png, gif, pdf, jpeg. Top Teeth Upload ImageAccepted file types: jpg, png, gif, pdf, jpeg. Bottom Teeth Upload ImageAccepted file types: jpg, png, gif, pdf, jpeg.
