How happy are you with your smile?*
I'm very unhappy with my smile
I'm somewhat unhappy with my smile
My smile is OK
I'm very happy with my smile
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How long has it been since your last dental visit?*
Never
I can't even remember
More than a year
Within a year
Within the last 6 months
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Do you have missing teeth?*
Yes, I am missing a single tooth
Yes, I am missing several teeth
Yes, I am missing all my teeth
No, I am not missing teeth
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Do you wear dentures or partial?*
Yes, I wear dentures or partial
No, I do not wear dentures or partial
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Do you have dental insurance?*
Yes, I have insurance
No, I do not have insurance
I don't know
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How soon are you wanting to fix your smile?*
Yesterday
This month
Within the next 6 months
Not really in a rush
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If the cost was affordable and would fit your budget, are you ready to invest in your smile?*
Yes, I'm ready
I'm ready but I still have questions
No, I'm still just thinking about it
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Are you interested in booking a FREE Evaluation to get a personalized treatment plan, detailed pricing, and all your questions answered?*
Yes, contact me to book an evaluation
No
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