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Treatment Details

Please answer these few questions about your teeth so we can identify and provide you with the best outcome and pre approve your treatment.
If you have had any of the following:

– Crowns ( front teeth)- Veneers- Bridges- Implants- Dentures

Unfortunately, Simply Straight is unable to treat you.

If you have any of the following:

– Overbite
– Underbite
– Crossbite

We may be unable to correct your situation. We will evaluate your case when we have received your photos.

1. Area of Treatment

2. Have you worn braces or clear aligners in the past?

3. Have you had any of the following? (Unfortunately we can not treat Crowns (front teeth),Veneers, Bridges, Implants or Dentures.)

4. Which option best describes your biggest concern with your smile right now?

5. Which payment option do you prefer?

6. Images of Your Teeth

Please Attach / email or message 5 or more images of your teeth clearly showing your upper jaw, lower jaw and teeth together to show your current bite. Please send images of all angles stated below:
1. Photo of teeth together
2. Photo of upper jaw (teeth)
3. Photo of Lower jaw (teeth)
4. Teeth together from the left
5. Teeth together from the right

Additional Questions
Please answer the last two questions for us to server you better in the future!

Do you hold any of the following?

How did you hear about us? *

First Name

Last Name

Confirm Email

Phone Number

Date of Birth

Address

City / Suburb

State

Post Code

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