Ann Arbor Orthodontics

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Submit Photos

Fill out this form and you’ll be entered for a chance to win a $250 cash prize! All submissions may be used for social media posts by Ann Arbor Orthodontics whether or not your submission is selected as the drawing winner. The deadline for submissions is May 31, 2025, so upload now!

First Name*

Last Name*

High School*

Are you a patient of Ann Arbor Orthodontics?

Email*

Phone Number*

What social media platforms do you use?

Legal Guardian Name (if under 18)

Note: If you try to upload images that are 8 MB or more, you might get an error. If that happens, either reduce the image size or email them using the instructions below.

Photo Upload 1 (JPG only)

Photo Upload 2 (JPG only)

Photo Upload 3 (JPG only)

Photo Upload 4 (JPG only)

Photo Upload 5 (JPG only)

Photo Upload 6 (JPG only)

What are your plans for after high school?

To be entered TWICE in our drawing, please leave us a review of your treatment experience at our office that will be put on our upcoming new website!

By checking this box I certify that I am 18 years of age or older (or have permission from my legal guardian.)

I hereby grant Ann Arbor Orthodontics permission to use my senior photo(s) for the purpose of advertising including, but not limited to, internal office postings, video display monitors, newspaper/magazine/billboard advertisements, promotional/educational materials, and company internet websites/social media. The supplied images shall NOT be distributed or exploited separately or independently of Ann Arbor Orthodontics.

If you are having trouble with the online form, just download and fill out the release form then email everything to seniors@a2ortho.com.