Free Virtual Assessment

With Chamberlain Family Orthodontics

We know that life is busy and your time is valuable, and that’s why we offer virtual care.

Find out if you’re a candidate for treatment from the comfort of your home. Dr. Chamberlain will assess your smile and let you know what type of treatment is right for you.

Plus, our team will research your insurance benefits and show you affordable payment options to help make your dream smile a reality.

How It Works

First, you'll start by telling us a little about yourself. Then, you'll snap a few pictures of your teeth.

Step 1:
Get your smartphone and someone to help you, then replicate these 8 photos below.

The better the pictures you send, the more we can see and discuss!

Need help taking photos?

A good way to help retract your cheeks away from your teeth during the photos is for you to hold your cheeks with 2 spoons, while your friend or family member takes the photos for you.

Step 2:
Fill out the form below.

Full Name*
Email*
Phone*
DOB*
Month
Day
Year
Preferred Location*
- Redlands
- Beaumont
Treatment Preference
- Metal Braces
- Clear Braces
- Invisalign
- InBrace
Do you have dental insurance coverage?*
- Yes
- No
Insurance Company
Subscriber Name
Subscriber DOB
Month
Day
Year
Subscriber ID
Subscriber’s Relationship to Patient
Upload Front and Back of Insurance Card
Drop files here or

Accepted file types: jpg, jpeg, png, gif, Max. file size: 50 MB, Max. files: 2.
Upload Up to 8 Pictures*
Drop files here or

Max. file size: 50 MB, Max. files: 8.
How Can We Help Your Smile?*
Phone
This field is for validation purposes and should be left unchanged.

Step 3:
All done! Dr. Chamberlain will review your photos and we will get back to you soon with your treatment options and how to begin your smile journey.

VERY IMPORTANT

When we send you an email, or you send us an email, the information sent is not encrypted. That means a third party may be able to access the information and read it since it is transmitted over the Internet. If you receive an email, someone may be able to access your email account and read it.

HIPAA stands for the Health Insurance Portability and Accountability Act.
HIPAA was passed by the U.S. government in 1996 in order to establish privacy and security protections for health information.
Information stored on our computers is encrypted.
Most popular email services (ex. Hotmail®, Gmail®, Yahoo®) do not utilize encrypted email.
Email is a very popular and convenient way to communicate for a lot of people, so in their latest modification to the HIPAA act, the federal government provided guidance on email and HIPAA.
The guidelines state that if a patient has been made aware of the risks of unencrypted email and provides consent to receive health information via email, then a health entity may send that patient personal medical information via unencrypted email.
For more information visit https://www.gpo.gov/fdsys/pkg/FR-2013-01-25/pdf/2013-01073.pdf.

By sending a request for virtual assessment via email you are accepting the terms and conditions of utilizing unencrypted email to communicate health information.