By Phone
If you have questions and would like to speak with a real person please call us at: (561)338-GRIN (4746).
By E-Mail
Send e-mail inquiries to info@bracesandfaces.com. We check our e-mail often, so you know you'll get a quick response!
By Request Form

You can also fill out this short form to request more information about our services. Please be sure to include your phone number and e-mail address.


Please print the appropriate form and fill it out. Then you can either bring it to your appointment or fax it to us at
(561)395-9391.

 
Your name:
Contact me by: Phone
E-Mail
 
E-mail address:
Home Phone: ( )
Work Phone: ( )
Best time to call you at home:
Best time to call you at work:  

Street address:
City: State: Zip:

Patient's name:
Patient's date of birth: Month Day Year
 
Has the patient ever consulted an orthodontist before? Yes No

Describe what you want to change about the patient's teeth or smile:
 
Patient's dentist name:
Dentist's telephone number with area code: ( )
 
Do you have orthodontic insurance benefits? Yes No