Virtual Consult

We want this process to be simple! Upload a quick selfie or an existing photo from your phone. Below are some examples:

By checking the box below, you agree to the Terms of Use listed here:

Any communications through our website or via email are not guaranteed to be encrypted or secure. Use of the internet and/or email is for your convenience only, and by using them, you assume the risk of unauthorized use.

By checking this box you hereby agree to hold City Smiles, its doctors and affiliates, harmless from any unauthorized use of your personal information by outside parties, hacking, or any other malfeasance. In conclusion, you understand that we will contact you as part of you completing this form.