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  • If you are an Existing Patient and just want to send images and X-rays skip to the bottom of this page.
  • If you are a New Patient seeking online treatment advise from Dr Landers or just want to give him a better understanding of your treatment desires, you should fill out as many forms on this page as time will allow, and  send your images. 
  • If you are a new or existing patient seeking same day care or treatment solutions for a painful dental problem, please help us to help you by sending images and filling out a short one-page form. After you are finished please call our scheduling coordinator and reference the images you sent.

If Your New to Our Office and Decide to Schedule With Our Office

  1. Transfer existing dental records from another office to ours: » Transfer Records To Our Office Request (Printable) 
  2. Fill Out New Patients Forms https://cosmeticdentistchicago.com/new-patients-forms/

4-Benefits Of Sending Smile Photos, and X-Rays with Descriptions of Your Treatment Goals

  1. Orientate the doctor regarding the specific treatments you are seeking.
  2. Allow us the option to review your case and schedule  an appropriate amount of time for your needs.
  3. Allow our team to prepare your treatment room with specific materials related to your dental needs and in advance of your visit.
  4. We can more accurately provide you with an estimate of treatments costs and insurance estimates before your visit.

Tell Us About Your Treatment Goals!

Please take the time to answer all questions, as these answers can be vital to ensuring you receive the most effective advise. We have found that patients who take the time to fill out all related forms end up with the best consults.

Request A Virtual Consult E-FormHighly Recommended!

Cosmetic Questionnaire E-FormImportant but Optional

The transmission of all the information you supply will not be shared with or sold to any outside party.

How to Send Photos & X-rays

Please upload 8 photographs, using the following guidelines when taking photos:


  • Brush & floss your teeth before taking images.
  • Solid background with good room lighting is best.
  • It’s easier if a photographer friend takes your pictures. If you’re taking the images by yourself, steady your camera & use a self-timer.
  • Full Face & Profile pictures are more diagnostic if taken while you are standing.
  • When taking images of your face, please make sure your hair is pulled back from the forehead and that the ears are visible.
  • Use Lip Balm or Vaseline if needed as it makes it more comfortable when retracting your lips.


No More Then 10 Images Per Submission

When Trying to Send More Then 10 Images -Use Multiple Submissions
–Otherwise No Images Will Send!

Full Face Images

  1. Face Smiling (like you are posing for a picture)

    Upload Photo:
  2. Face With Laughing Smile
    - Natural Laughing Expression (do not pose)
    - Face the Camera/ Do not Turn Away

    Upload Photo:
  3. Face Profile Smiling (include Head & Neck)

    Upload Photo:

Smile Images

  1. Smile Straight On (Close up of just your smile) Example:

    Upload Photo:

Teeth Images

  1. Close Up Teeth Biting (Lips retracted off of Upper Teeth & Lower Teeth)

    Upload Photo:
  2. Close Up Top Teeth & Gums (Lips retracted off of Upper Teeth & gums)

    Upload Photo:
  3. Head tipped Up & back (Images of chewing surfaces Upper Teeth)

    Upload Photo:
  4. Head tipped Down (Images of chewing surfaces of Lower Teeth)

    Upload Photo:

Dental X-Ray Images
Upload your most recent Dental X-rays
*Upload Photos:

If you have any trouble uploading your photographs or submitting your information, please contact our office and we would be happy to assist you.


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