Dental Patient Image Upload
Please upload a valid form of identification with photo ID. E.g. Drivers License, State Issued ID, Military ID, etc. We accept the following image formats JPEG, JPG, PNG, GIF, and TIFF. Max file size is 10 Megabytes (MB).
Drag & Drop Files Here
Please use your mouse or touchpad to sign your name in the grey section below, then click “Submit Form” to submit your request.