Please fill out the order form below to submit your practice's payment information for the My Smile Choice™ program.
My Smile Choice™ Program | Single Location
Set-up Fee: $1895 $895 (one-time fee)
Monthly Fee: $349 (auto-pay on the first of each month)
Questions? Give us a call!
Step 1: Account Information
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Step 2: Billing Details
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Step 3: Payment Information
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SUBMIT
By submitting this form, you agree to our Terms of Use and Privacy Policy.
What you'll get:
  • Adoption into a community of Orthodontists
  • Listing on MySmileChoice.com
  • In-office Implementation Kit
  • Defined Guidelines & Processes for 3 Levels of Aligner Treatment
  • Consultation Scripting Guide
  • My Smile Choice™ Consult Laminate
  • New Patient Contact & Intake Guide
  • Patient Consent Form
  • Customized Brochures
  • Customized Pass-Along Cards
  • My Smile Choice™ New Program Flyer
  • Easy to follow Marketing Plan
  • Micro-Site w/custom URL
  • Social Media Post Images & Captions
  • Two 45-min consultation calls
  • Simple Integration Worksheet & Checklist
  • Customized New Patient Intake Form
  • Consult/Case Financial Tracker
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