Virtual Exam Step 1 of 4 - Smile Concerns 0% Are you a current patient or new patient?*(Choose any that apply.) New Patient Current Patient Is this an emergency or non-emergency?*(Choose any that apply.) Emergency Non-Emergency What's the concern/issue What is the concern/issue?*(Choose any that apply.) Overbite / Underbite Crowding / Crooked Teeth Spacing / Gaps Other (please specify) Other Generally speaking, what time of day is best for you?*(Choose any that apply.) Morning Afternoon Patient Information We will be reviewing your photos and concerns. We'll be in touch shortly!Patient's First Name* Patient's Last Name* Patient's Date of Birth* MM slash DD slash YYYY Phone* Email* Preferred Office Location* Vernon Hills Glenview Δ
