Patient Tracking Form: Orthodontic Plate
Take pictures of your smile and submit those photos using the form below for the doctor to review when required
We would like to see your progress by filling out the form below. Please take photos with and without your plate on.
This page and form works well on mobile devices, so you can take the photos on your phone, and navigate to this webpage on your device to fill out the form and attach the photos directly from your phone.
Fill out your details and upload a few photos
Send the completed form and photos to Alpers Dental
One of our friendly dentists will be in contact with you