Virtual Appointment | oakley

2170 Main St. #E | Oakley, CA 94561 | Phone: 925-392-1216 | Fax: 925-308-4633 | Email:

VIRTUAL APPOINTMENT

Grab you phone, snap a selfie and start your virtual Orthodontic visit!

How it Works

Complete patient information, and upload photos below. Dr. Hardyk will assess your smile and get back to you with instructions on what comes next!

Patient Information

First Name

Last Name

If Minor, Parent Full Name

Email Address

Phone

Preferred Method of Contact

I am a::

If a current patient, what tray are you wearing?

Do you have any concerns?

Upload Your Photos

To begin your consultation, you will need the following:

1) A family member or friend

2) A cell phone camera

3) Two plastic or metal spoons

Please wait for the image name to appear to ensure your photos have been uploaded, it may take a minute depending on image size and internet connection.

Retract cheek with spoons, back teeth together and take photo straight on

Upload File

Upload supported file (Max 15MB)

Right side teeth together with cheek retracted with spoon

Upload File

Upload supported file (Max 15MB)

Left side teeth together with cheek retracted with spoon

Upload File

Upload supported file (Max 15MB)

Tip head back, open wide and have a friend take the photo

Upload File

Upload supported file (Max 15MB)

Tip head down, open wide and have a friend take the photo

Upload File

Upload supported file (Max 15MB)

*Clear aligner patients only Please repeat photos while wearing aligners

Retract cheek with spoons, back teeth together and take photo straight on

Upload File

Upload supported file (Max 15MB)

Right side teeth together with cheek retracted with spoon

Upload File

Upload supported file (Max 15MB)

Left side teeth together with cheek retracted with spoon

Upload File

Upload supported file (Max 15MB)

Tip head back, open wide and have a friend take the photo

Upload File

Upload supported file (Max 15MB)

Tip head down, open wide and have a friend take the photo

Upload File

Upload supported file (Max 15MB)

Any additional comments?

Thank you for submitting your form!

VIRTUAL CONSULTATION

VIRTUAL APPOINTMENT