Your Name
What are your main concerns with your teeth?
Do you have a preferred treatment method?
Now we need to capture some photos of your smile. You will need to take 5 photos of your teeth so that Dr Gullotta can assess your smile and bite.
Image 1 Example: Centre
Image 2 Example: Left Side
Image 3 Example: Right Side
Image 4 Example: Upper Teeth
Image 5 Example: Lower Teeth
Please upload any additional information or documents you may have, such as a dentist referral.