Please fill out the form and attach photos below so we can provide you with as accurate of an assessment as possible. If you have any issues with the form, you can also email your photos directly to us at smile@goorthotampa.com.

Note that the form on our website is not able to accept large file sizes, so please be sure to upload photos that are 10mb or less.

"*" indicates required fields

New Patient?*
img-preview
img-preview
img-preview
lower teeth
Accepted file types: jpg, png, Max. file size: 64 MB.
Accepted file types: jpg, png, Max. file size: 64 MB.
Accepted file types: jpg, png, Max. file size: 64 MB.
Accepted file types: jpg, png, Max. file size: 64 MB.