Patient Photo Upload

Dear Doctor,

Below is a form we use to collect information about the before and after cases photos, you submitted to us for use on the “Real Solutions” Smile Gallery and other pages of the Smile Docs®. We will also be using these photos in promotional materials (web and print) we will be designing for you.

Please provide the following information for each individual or set of photos you submitted:

1. Upload Patient Photos for Case Presentation
Please upload clear photos of your patients in a JPG or PNG format. (headshots should be square in size and intra-oral pictures should be horizontal). NOTE: Please upload photos for one patient case at a time. Each individual case should be submitted separately.

2. Provider Full Name
Please add the full name of the provider who did the work for the case being presented.

3. Patient’s Name:
Please add the patient’s full name in the spaces provided.

4. Patient’s Chief Complaints/Concerns:
Here you will explain what was your patient’s complaints or concerns were about their teeth and/or smile. Please write in a conversational tone and limit your description to 196 characters max.

Important: What you write is what will appear, we will not be checking for grammar or spelling errors so please take your time and check your work.

5. Your Solutions/Work Performed:
Here you will state the dental work you provided as part of your treatment plan. (e.g. Veneers front teeth plus lower teeth whitening). If you desire, you can also add the time it took to complete the work (e.g. All work was completed in 4 visits). Please write in a conversational tone and limit your description to 196 characters max.

Important: What you write is what will appear, we will not be checking for grammar or spelling errors so please take your time and check your work.

6. Photo Usage Disclaimer
Please check the box if you have been given permission by your patient to use their photo(s) in your print and web promotions including Smile Docs® website, social media and promotional pieces.

Please complete a separate form for each case you are presenting.

Sincerely,

The Smile Docs® Team:

Here is a sample:

All sections marked with an asterisk are mandatory:


  • Please upload clear photos of your patients in a JPG or PNG format.
    Drop files here or
  • By selecting this box I acknowledge that I have obtained consent from this patient to use their photo(s) in my marketing and web promotions including my pages on the Smile Docs® website/print materials.
Terms & Conditions
Free Smile Assessment Offer:
  1. Must be over 18 years of age
  2. Free Smile Assessment consultation must be face to face
  3. Includes : Smile analysis, Facial lines and asymmetries, Teeth size, shape and position analysis, Teeth color recording, Jaw analysis, General tooth and gum health assessment and advise on the suitability for Invisalign or other Smile Make-Over procedures and recommendations.
  4. Does not include a full examination, x-rays or a scale and polish.
  5. Free Smile Assessment offer can be used in conjunction with other offers such as Whitening, Check up and Polish, and Invisalign offers.

Any surgical or invasive procedure carries risk. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. This offer may change without notice.