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

Tuesday morningTuesday afternoonThursday morningThursday afternoonFriday morningFriday afternoon
I am requesting this appointment for:*
Name*

First Name Last Name
Birth Date*

MonthDay 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*

MonthDay 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:*

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

Free Consult Request