Online Video Orthodontic Exam : Freytag Orthodontics Video Exams

Watch Our Instructional Video

Yay!! We are so excited that you decided to participate in our Online Video Exam. Our Instructional Video will tell you everything that you will need to know.
Tell Us A Little About Yourself
Patient Full Name*
First Last
Patient's Dentist*
Patient's Date of Birth*
Month
Day
Year
Please let us know the best way to contact you*
Choose the video chat service you'd prefer for the online video exam:
- Facetime
- Skype
Video Chat Contact*
Phone # (Facetime) or Username (Skype)
Message
Would you like to book now, or have someone connect with you?*
- Book Now
- Call Me
- Text Me
- Email Me
Preferred Day to be Contacted*
Preferred Time to be Contacted*
Responsible Party Name
First Last
Responsible Party Cell*
Cell Phone Provider*
for text reminders
Cell Phone Provider*
Responsible Party Email*
Age*
- I certify that I am 18 years or older
- I am under the age of 18 years
Parent or Guardian's Name*
First Last
Parent or Guardian's Phone*
Parent or Guardian's Email*
How did you hear about us?*
How did you hear about us? (Other)
Team Member Name(s)*

Watch Our Instructional Video