How is the current condition of your teeth and smile impacting you?

I'm embarrassed. My smile affects my confidence.

I'm not embarrassed, but I want to look better.

This is about how I feel more than I how I look.

What is causing you the most frustration?

My teeth are crooked

There are gaps between my teeth

I don't like the shape of my teeth

I have a "gummy" smile

My teeth are badly worn and chipped

I have old dental work that is unattractive

I have missing teeth that cause me frustration

On a scale of 1 to 10, how important is it to you to fix your smile?

BadGood

When do you want to get started?

I want to get started right away.

I hope to start in the next 30-60 days.

I need a few months to get ready.

Maybe someday, but not soon.

How would your life improve if we’re able to help you?

Finally, are you committed to attending your appointments; responding to our team by text, email, or phone when needed?

Yes

No

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