How the Online Smile Consultation Works

STEP 1

To start your Video Consultation, fill out the form below and submit your photos. Tell us what you hope to change with your smile.

STEP 2

Once you fill out the form, you will receive a confirmation email from our office that we received your Video Consultation request.

STEP 3

Dr. Steven H. Poulos, DDS will personally email you with a personalized video, addressing your concerns and providing his recommendations on how to improve your smile.

Video Consultation Form

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    Upload a Close-Up picture of your smile from the front. Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)

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    Upload a Selfie of your face and smile (Optional). Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)

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    Upload a Close-Up picture of your smile from the right side. Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)

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    Upload a Close-Up picture of your smile from the left side. Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)

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    HIPAA Acknowledgment
    Please be aware that this is a secure email network under HIPAA guidelines. Do not submit any personal or private information unless you are authorized and have voluntarily consented to do so. We are not liable for any HIPAA violations. Understand that if you email us, you are agreeing to the use of this secure method and understand that all replies will be sent by standard (unsecured) email, which you are hereby authorizing. By checking this box you hereby agree to hold Dr. Steven H. Poulos, DDS, including its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.