Virtual Consultation Request

At Tollgate Orthodontics, our staff and Dr. Eves, our board certified orthodontist, aim to make creating a beautiful smile convenient and affordable through different types of treatment including braces, Invisalign and more. Find out if treatment is right for you from virtually anywhere with just a few easy steps.

The Tollgate Orthodontics Virtual Smile Consult is available for potential patients aged 16 and older in East Greenwich, Warwick and surrounding areas. Patients younger than 16 may have conditions which are only properly assessed with more complete records of their teeth.

Complete the information below and then text the requested photos to 401-287-4279. Once Dr. Eves has reviewed your information, we’ll reach out to you with his recommendations. It’s that easy!

tollgateorthodontics.com - Virtual Smile Consult

* Patient Name: (Required)

Parent Name(s): (If patient is a minor)

New Patient? Yes No

Patient Date of Birth:

E-mail:

Phone Number:

Home Address:

City:

State:

Zip:

Gender:

Preferred Days:

Convenient Times:

How did you hear about our practice?

What is your primary smile concern?

Primary Insurance Company:

ID Number:

Comments (Describe your goal for your smile):

* I understand that the Tollgate Orthodontics Virtual Consult is not a comprehensive diagnosis and that further records may be needed in order to provide the best care.

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Virtual Smile Consult Request

Virtual Consultation Request