Appointment Request

Free Consult Request

Let us know what services you are looking for and we'll book you a free consult! You are also welcome to call our office directly at (615) 675-0050 to schedule.
For more information about our clinic, our doctor, and our orthodontic treatments, please visit genuineorthodontics.com.
Which are you interested in? (select all that apply) *

Free braces consultation Free Invisalign® consultation Free InBrace® consultation Retainer repair/replacement consultation
What day and time work best? (select all that apply) *

Tuesday morning Tuesday afternoon Thursday morning Thursday afternoon Friday morning Friday afternoon
I am requesting this appointment for: *
Name *

First Name Last Name
Birth Date *

Month Day Year
Date
Phone Number *
Please enter a valid phone number.
Email *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Child's Name *

First Name Last Name
Child's Birth Date *

Month Day Year
Date
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Phone *
Please enter a valid phone number.
Parent/Guardian Email *
example@example.com
Parent/Guardian Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please confirm my appointment via: *

Phone Email Text
How did you hear about us: *
Please verify that you are human *
Should be Empty:

Free Consult Request