When was your last dental cleaning or checkup? *

Within the last 6 months

6 months to a year ago

1 to 2 years ago

More than 2 years ago (welcome back, we're glad you're here)

What brings you to South Shore Smiles today? (Check all that apply) *

A routine cleaning and exam

Something hurts or feels off

I want a brighter, whiter smile

I'm interested in straightening my teeth

I need to replace or repair a tooth

I'm just shopping around for a new dentist

How would you describe your smile right now? *

Happy and confident

Pretty good, but room to improve

A little self-conscious about it

I tend to hide it in photos

Are you dealing with any of these? (Check all that apply) *

Tooth sensitivity to hot or cold

Bleeding or tender gums

Jaw soreness, clicking, or teeth grinding

A chipped, cracked, or missing tooth

Bad breath I can't shake

None of these, just here for maintenance

How do you feel about dental visits? *

I look forward to them

They're fine, no big deal

A little nervous, but manageable

They make me pretty anxious

What's the best way to reach you to confirm your appointment? *

Text

Phone call

Email

Full Name *

Email *

Phone *