Join the waitlist

Let’s get to know you better!

Your info

First Name*

Last Name*

City*

State*

Date of Birth

Your communication preference

Your Email*

Your Phone

How would you prefer to be contacted for appointment scheduling and updates (email, phone, text)?*

Your dental story

Have you had orthodontic treatment before?

Do you have any missing teeth or dental implants?

Any history of gum disease or oral health issues?

Do you smoke or vape?

List any dental concerns or specific goals for treatment.

Additional comments

How did you find us?*

Is there anything else you’d like to share or any specific questions you have about the treatment?

Voluntary self-identification

Why we’re asking:

We’re curious and love getting to know our community better!
It might help us personalize our services to fit your needs.
We’re conducting a little research (no lab coats here, though!).
It’s related to a health assessment.

Your Say Matters:

We value your trust and privacy. Your responses are entirely voluntary, and you’re in control. Your info will only used for the purposes mentioned above.

I consent

By completing this form, you’re helping us understand our community better, and for that, we thank you.

Thank you! Your submission has been received!

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