Virtual Orthodontic Consultation

Would you like to know if orthodontic treatment is right for you? Our Virtual Orthodontic Consultation can start the conversation for you! To begin, simply email Dr. Beisiegel a few photos and any questions you have regarding your smile. Dr. Beisiegel will review your photos within 24 hours and provide you with his initial recommendations on orthodontic care for your smile.

Use your cell phone camera and a friend or family member to help you take a series of photographs similar to the samples shown below. Quick tip – using your fingers or a clear plastic spoon to pull your cheeks to the side really helps with the side photos.

Then, click on the corresponding example images below to upload your photos to Dr. Beisiegel. This will help him best evaluate your smile. Don't worry if you can't take them all, just do your best and we can always ask for more information if necessary. We look forward to seeing your smile soon! When emailing your photos and concerns be sure to include:

Upload Your Smile Photo

Smile!

Upload Your No Smile Photo

Bite down and relax your lips.

Upload Your Profile Photo

Bite down and relax your lips.

Upload Your Overbite Photo

Stretch your cheeks and bite down naturally

Upload Your Upper Arch Photo

Tilt your head back and take a picture of your upper arch.

Upload Your Lower Arch Photo

Tilt your chin down and take a picture of your lower arch.

Upload Your Right Bite Photo

Bite naturally capturing your molars.

Upload Your Left Bite Photo

Bite naturally capturing your molars.

Additional Images (Please Select all photos to submit at one time, 4 max)

Your Name

Patient Name

Home Phone

Cell Phone

Reason for seeking a virtual consultation:

New Patient Exam

Observation of Growth Visit

Active Treatment Visit - Braces

Active Treatment Visit - Invisalign

Retainer Evaluation

We will review your photos and get back to you as soon as possible.

VERY IMPORTANT! PLEASE READ!

Email is a very popular and convenient way to communicate for a lot of people. In the latest modification to the HIPAA act, the federal government provided guidelines on email and HIPAA. The guidelines state that if a patient has been made aware of the risks of unencrypted email, and that same patient provides consent to receive health information via email, then a health entity may send that patient personal medical information via unencrypted email. For more information visit https://www.gpo.gov/fdsys/pkg/FR-2013-01-25/pdf/2013-01073.pdf.

When Maple Leaf Orthodontics sends you an email, or you send Maple Leaf Orthodontics an email, the information that is sent is not encrypted. This means a third party may be able to access the information and read it since it is transmitted over the Internet. In addition, once the email is received by you, someone may be able to access your email account and read it.

By sending a request for virtual consultation with email you are accepting the terms and conditions of utilizing non-encrypted email to communicate health information.

Virtual Orthodontic Consultation

VERY IMPORTANT! PLEASE READ!

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354 Mountain View Dr., Suite 100 | Colchester, VT 05446