Submit Your First Case for No Charge

See how SmilePix cosmetic dental imaging can benefit your practice.
If you need help taking a smile portrait, go HERE.
How the SmilePix process works.

SmilePix Order Form
Dentist Information
You must fill in these fields* in order to submit the form.
First Name:*
 Last Name:*
Company Name:
Street Address:*
City:*
 State:*
 Zip:*
Country (if not USA)
Telephone:*
 email:*
How did you hear about SmilePix:
Colleague's name or Seminar:

Patient Information

Patient Name*
For Free Case, Send Full Face Photos Only.

Click Here and find out how easy it is to make a good smile portrait
Maxillary
 Mandibular
Gingival Contouring
 Ideal Smile
Whitening
 Teeth Coloring
LVI shape desired

Click HERE to see the
12 LVI Styles		 Lorin Library

Click HERE to see the
18 Lorin Library Styles
In the box below you can give us detailed instructions.

Press Submit and than find your patient's file
on your hard drive and upload the photo.