Bitewise Orthodontics

Let's take a look at your smile

This takes about 10 minutes, all from your phone. You'll answer a few quick questions and take five guided photos. Dr. Clay reviews every submission personally and follows up with preliminary thoughts and next steps.

Your answers and photos are encrypted, stored privately, and seen only by our team — never posted publicly.

First, who is this assessment for?

Please enter the patient's name. If the patient is a minor, also enter the parent or legal guardian who can receive the response.

Patient

Parent or legal guardian (if applicable)

How can we reach you?

We'll use this email to verify your submission and send a secure link when your review is ready.

Tell us a bit more

This helps us tailor your assessment.

If this assessment is for a minor, enter their age.

What would you like to improve?

In your own words — there are no wrong answers.

How did you hear about us?

Optional — but it helps us a lot.

Now for your photos

Five quick shots, one at a time. Use good light and either take a new photo or upload one from your phone or computer. A simple trick: pull your cheeks back with your fingers (or use a clean spoon) so we can see your teeth clearly. Don't worry about getting them perfect.

At least one photo is required for a smile assessment. The remaining photos are optional, but each one helps Dr. Clay give you a more useful preliminary review.

One last thing

Please confirm your assessment authorization. You can also choose whether ordinary email or text is okay for future communication.

Consent to Receiving Electronic Communication (optional)

I authorize Bitewise Orthodontics to communicate with me by email and/or text message (SMS) about this assessment, including appointment reminders, scheduling, billing matters, test results, and other administrative or health-related information for me or the patient identified above, as applicable.

I understand that regular email and text messaging may not be fully secure, and information could be accessed by an unauthorized party. Bitewise Orthodontics will take reasonable steps to safeguard my information in accordance with HIPAA and applicable Texas privacy laws, but cannot guarantee the security of communications sent electronically or over cellular networks. Message and data rates may apply.

I may revoke this permission at any time: for email, by notifying the office in writing; for text messages, by replying “STOP” or notifying the office. Revocation will not affect communications already sent or my ability to receive care. I am responsible for notifying Bitewise of changes to my email address or mobile number and for safeguarding access to them.

Choose one or both if you agree

Verify your email

We sent a six-digit code to the email you entered. Enter it below to finish your submission.

Thank you!

Your smile assessment is on its way to Dr. Clay. He personally reviews every submission and will follow up by email with preliminary thoughts and next steps. Keep an eye on your inbox.

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