Help us to expedite an initial assessment of your case by completing the following quiz. A staff member will be happy to answer any of your questions and schedule an appointment for you.
Thank you for considering our practice for your dental care.

A Quiz to Help You Obtain the Smile You’ve Always Wanted
Hold a mirror 12”-14” from your face. Smile to how your teeth. Take the time to observe your teeth carefully, then answer the following questions.

I would like to be addressed as:*
Email address:*
1. Do you like the appearance of your smile? Yes No
2. Are your teeth all straight? Yes No
(If no please explain)

 

3. Do you have spaces that you don’t like? Yes No
(If no please explain)

 

4. Do you like the color of your teeth? Yes No
(If no please explain)

 

5. Do you like the shape of your teeth? Yes No
(If no please explain)

 

6. Are your teeth chipped? Protruding Hidden
7. Are your teeth wearing on the biting surfaces? Yes No
8. Are there old fillings or dental work you don’t like looking at? Yes No
(If no please explain)

 

9. What would you like to change the most in the appearance of your teeth?

 

10. How would you like your teeth to look?