BACK
CONSULTATION
CHECKOUT
Tab 1
Tab 2
Tab 3
Tab 4
Tab 5
Tab 6
Tab 7
Complete your consultation to get your order
All it takes is 1 minute
CONTINUE
Have you been diagnosed with any of the following?
Temporomandibular Joint Disorder (TMJ)
Temporomandibular Disorder (TMD)
Bruxism (teeth grinding or clenching)
Sleep Apnea
None of the above
BACK
CONTINUE
Have you undergone any recent dental surgeries or procedures?
Yes, within the past 6 months
Yes, but more than 6 months ago
No
BACK
CONTINUE
Is your bit misaligned (i.e., overbite, underbite, or crossbite)?
Yes, I have a noticeable misalignment
No, my bite is properly aligned
I'm not sure
BACK
CONTINUE
Do you have "buck teeth" or prominent front teeth that extend significantly beyond the lower teeth?
Yes
No
I'm not sure
BACK
CONTINUE
Anything alse you want your provider to know?
No, i've provided all relevant information and have no questions. Thank you!
BACK
Do you currently wear braces or a dental retainer?
Yes, I wear braces
Yes, I wear a retainer
No
BACK
CONTINUE
Perfect! Let's get you
checked
out
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
Edit the form in here:
Have you been diagnosed with any of the following?
Temporomandibular Joint Disorder (TMJ)
Temporomandibular Disorder (TMD)
Bruxism (teeth grinding or clenching)
Sleep Apnea
None of the above
BACK
CONTINUE
Have you undergone any recent dental surgeries or procedures?
Yes, within the past 6 months
Yes, but more than 6 months ago
No
BACK
CONTINUE
Is your bit misaligned (i.e., overbite, underbite, or crossbite)?
Yes, I have a noticeable misalignment
No, my bite is properly aligned
I'm not sure
BACK
CONTINUE
Do you have "buck teeth" or prominent front teeth that extend significantly beyond the lower teeth?
Yes
No
I'm not sure
BACK
CONTINUE
Do you currently wear braces or a dental retainer?
Yes, I wear braces
Yes, I wear a retainer
No
BACK
CONTINUE
Perfect! Let's get you
checked
out
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
.svg)