Virtual visit

Virtual visit for current patients

Let’s keep your treatment on track. Help us keep an eye on your smile by checking in with Dr. Periago virtually.

Step 1:

Take 8 pictures of your smile from these angles.

Step 2:

Fill out the form below.

"*" indicates required fields

FIrst Name*

Last Name*

Email*

Phone*

Date of Birth*

If you are wearing rubber bands, how many hours/day are you wearing them?*

Is anything loose or broken?*

Yes

If have aligners, how many hours a day are you wearing them?*

How many times a day are you brushing?*

Upload up to 8 pictures*

Drop files here or

Max. file size: 50 MB, Max. files: 8.

Any questions regarding your appliances?

Step 3:

You’re finished! We will assess your photos and will get back to you soon with more information.

Important notice

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 that same patient 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 visit with email you are accepting the terms and conditions of utilizing non-encrypted email to communicate health information.