Park Dental Aligners Photo Upload

Customer Photo Submission

* First Name

* Last Name

* E-mail Address

* Doctors Name

* Impression Kit Serial #

Smile Photo Upload 

Please follow the smile photo instructions carefully outlined in your impression guide booklet.

* Upload Smile Pic Front View

Upload Photo   .gif, .jpg, .jpeg, .png

* Upload Smile Pic Left View

Upload Photo   .gif, .jpg, .jpeg, .png

* Upload Smile Pic Right View

Upload Photo   .gif, .jpg, .jpeg, .png

Customer Photo Consent Terms & Agreement

Do you consent to Park Dental Aligners, by Park Dental Research Corp. use of your photos (before and after) for treatment planning and marketing purposes?

If you do not wish for your photos be used for marketing purposes please select no and your photos will only be used for your treatment plan.

* Consent Agreement

* All the info submitted is accurate and true

Submit My Photos
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