[Practice Name][Client logo + name from intake]

Illustrative smile preview

See what's possible for your smile.

Choose what you'd like to improve, add one clear selfie, and see an illustrative preview before your consultation at [Practice Name].

1 · What would you like to improve?

Missing teethImplants · bridges · full arch VeneersReshape & brighten Smile makeoverThe full picture

2 · Add one selfieTap to take or upload one selfieFace the light · no filters · smile naturally · JPG or PNG

Illustrative concept only — not a diagnosis, a treatment guarantee, or a prediction of your individual result.

Generate my smile preview

Private & secureFast previewNo obligation

Privacy·Terms·[Client legal links]

BackStep 2 of 5

How do you plan to pay?

If you decide to move forward, how would you prefer to pay?

Just a preference — it helps the team prepare the right options. Nothing is binding.

Cash / self-payPay directly, no financing FinancingMonthly payments through a financing partner

Your answers stay private — used only to prepare your consultation.

BackStep 3 of 5

Where should we send your preview?

We'll send your preview link by text and email, with a personal next step from [Practice Name].

First name

Last name

Mobile phone

Email

[Practice Name] may contact me by text, call or email about my smile preview and consultation.Required Send me occasional offers and smile tips from [Practice Name].Optional

Continue

By continuing you accept the Privacy Policy and Terms of [Practice Name]. Your selfie is never shared without your consent.

BackStep 4 of 5

Reserve your consultation

Claim your $29 Smile Consultation Voucher

You've seen what's possible and the team has your details. The voucher reserves your consultation — and it's risk-free.

What's included

A consultation with Dr. [Provider] — exam, your options, and honest answers

Your smile preview, reviewed together — see what's possible for your smile

Your $29 credited toward treatment if you decide to move forward

Our promise

Decide not to move forward after your consultation? You get a full refund — no questions asked.

The voucher is non-refundable only if you miss your appointment without rescheduling.

Secure checkout on the practice's own payment page · receipt by email

Pay & claim my voucher · $29 Skip for now

[Practice Name][Client logo + name from intake]

Call

Thanks, [First name]. Your smile preview is ready.

Smile preview complete

Information securely submitted

Voucher claimed

Your smile preview

Before

AI after

Illustrative concept only — not a diagnosis, a treatment guarantee, or a prediction of your individual result.

A message from Dr. [Provider]

[Practice-approved video]Dr. [Provider Name] · [Practice Name][0:45]

What happens next

1The dental team reviews your smile and informationYour preview, goal and answers go straight to [Practice Name].

2[Practice Name] contacts youBy call, text or email — usually [within one business day].

3Your consultation is scheduledAfter you've spoken with the practice, so the visit fits your plan.

Request a call Call [Practice Name] now Demo: see what the practice sees →

Privacy·Terms·[Client legal links]

RewardLion OS · [Practice Name]Leads · demo view

New lead · just now

Maria Lopez

PRIORITY

Treatment—

Smile

Payment—

Budget / credit range—

Co-signer—

Voucher—

Consent

Source[Campaign / ad set]

CALL SMS EMAIL VIEW SMILE MARK CONTACTED SCHEDULE

Demo of the practice-side card. In the build this lives in the practice's RewardLion OS dashboard and the same lead fires to their CRM by webhook.

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