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Photos

Comments

Patient Name *

Patient Birthdate *

Month

Day

Year

Are you in Treatment with Simply Orthodontics?

Yes - Clear Aligners

Yes - Braces or Attached Appliances (e.g. space maintainer, expander, other)

Yes - Wearing Retainers

Not Yet - in Growth Monitoring

Include these photos for review by our team (with aligners if provided):

Side

Front

Other Side

Top

Bottom

Your Email Address

Aligner Number *

How many days per aligner? *

Approximately how many hours per day are you wearing your aligners? *

Are you wearing elastics as prescribed?

I wasn't prescribed elastics

Yes, I am wearing my elastics as prescribed

No, I have not been wearing my elastics as prescribed

Addition Information

Are you feeling comfortable? Let us know if you have any concerns about how your bite or smile is changing or how your aligners are fitting, or if you need additional elastics.

Dentist & Dental Office Name

Our team often communicates with your Dentist to coordinate your care. Please confirm your Dentist name and/or Dental Office name, or enter 'none' if not currently with a particular Dentist.

Simply Orthodontics is a specialty practice in Edmonton Alberta. Dr. Marguerite Duncan is a specialist licensed with the Alberta Dental Association, with a Master’s Degree in Orthodontics from the University of Alberta.

Simply Orthodontics | 10150 150 Street, Edmonton, AB, T5P 1P1 | Phone: 780-756-7600 Fax: 780-756-7070

Virtual Smile Assessment

Great news - your photos are in!

Your check-in is completed instead of a scheduled in-person appointment -- no waiting room and no travel time.

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Please contact us directly at info@simplyortho.ca, or by calling 780-756-7600.