How the Online Smile Consultation Works

STEP 1

ITo start your Video Consultation, fill out the form below and submit your photos. Tell us what you hope to change with your smile.

STEP 2

Once you fill out the form, you will receive a confirmation email from our office that we received your Video Consultation request.

STEP 3

Dr. Mark Arooni will personally email you with a personalized video, addressing your concerns and providing his recommendations on how to improve your smile.

    Video Consultation Form

    image1

    Max. file size: 2 GB.

    Upload a Close-Up picture of your smile from the front. Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)
    image1

    Max. file size: 2 GB.

    Upload a Close-Up picture of your smile from the front. Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)
    image1

    Max. file size: 2 GB.

    Upload a Close-Up picture of your smile from the front. Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)
    image1

    Max. file size: 2 GB.

    Upload a Close-Up picture of your smile from the front. Max file-size allowed is 10mb. (formats allowed: jpg, jpeg, gif, png)

    By checking this box, I acknowledge my understanding the HIPAA Policy and agree with its contents.

    HIPAA Acknowledgment
    Please be aware that this is a secure email network under HIPAA guidelines. Do not submit any personal or private information unless you are authorized and have voluntarily consented to do so. We are not liable for any HIPAA violations. Understand that if you email us, you are agreeing to the use of this secure method and understand that all replies will be sent by standard (unsecured) email, which you are hereby authorizing. By checking this box you hereby agree to hold DR. STEVEN POULOS, including its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.