Please fill out the order form below to submit your practice's payment information for the My Smile Choice™ program.
My Smile Choice™ Program | Two Locations

Set-up Fee: $1895 $1,495 + $485 (second location) one-time fee paid now

Monthly Fee: $349 + $49 (second location) auto-paid on the first of each month

Questions? Give us a call!
Step 1: Account Information
settings
settings
settings
settings
Step 2: Billing Details
settings
settings
settings
settings
settings
settings
Step 3: Payment Information
settings
settings
settings
settings
settings
settings
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
BRILLIANTDOC 2019 | Privacy Policy | Terms Of Use | Disclaimer
[bot_catcher]