Uptown Orthodontics Virtual Assessment Request Form
We are eager to meet with you virtually in lieu of an in-person appointment during this period of our lives where it is unfortunately unsafe to be together. We are providing this opportunity in an effort to continue to guide your treatment, answer your questions, address your concerns, and provide you with comfort on any upcoming procedures that may be required when the time is right.

For the majority of our patients, we will be using a popular, safe, and highly-regarded videoconferencing application called Zoom to execute these FaceTime- or Skype- style virtual visits.

[Note: For patients being treated with Invisalign, we are able to direct you to Invisalign's revolutionary "virtual care" interface to even more accurately monitor your treatment and provide specific recommendations. If you are an Invisalign patient, please complete this form, but note that you may not require the videoconference aspect of the assessment.]

As a general rule, your virtual visit should be anticipated within a week of your planned (but now canceled) in-office visit. That said, depending on your responses below, an adjustment may be made to this guideline at the discretion of your doctor.

NOTE THAT THIS VIRTUAL ASSESSMENT VISIT IS ONLY APPLICABLE TO EXISTING PATIENTS OF UPTOWN ORTHODONTICS

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In order to proceed with your virtual visit, we require the following 4 things:

1. COMPLETION AND SUBMISSION OF THE FORM BEGINNING ON THE NEXT PAGE
(requires 2-5 minutes of your time)

2. SUBMISSION OF A SET OF PHOTOGRAPHS AS DESCRIBED BELOW
(requires approximately 5-15 minutes of your time)

3. DOWNLOAD AND INSTALLATION OF THE ZOOM APPLICATION TO YOUR VIDEO-CAPABLE DEVICE AT LEAST 10 MINUTES PRIOR TO YOUR ALLOTTED TIME
(this quick and simple process will be prompted when clicking the "Join Zoom Meeting" link which will be provided to you in an email you will receive from our office; this email will be distributed to you anywhere from a few weeks to a few days prior to your virtual visit)

4. COMMITMENT OF THE PATIENT AND ANY INTERESTED FAMILY MEMBERS TO BE AVAILABLE FOR THE VIDEOCONFERENCE AT THE TIME SCHEDULED BY OUR TEAM
(once scheduled, please place the virtual visit in your personal calendar and set a reminder to ensure it can occur as planned)

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Thanks for understanding and complying with these necessary steps in order to maximize the outcomes of this initiative.

We're excited to see you and your teeth on our screens!

Be well,


Dr. Devon Anholt | Dr. Brent Yaremko

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