Are any of your teeth yellow, stained or somewhat discolored?*
YesNo

Would you like your teeth to be whiter?*
YesNo

Do you have any gaps or spaces between your teeth?*
YesNo

Are any of your teeth turned, crooked, or uneven?*
YesNo

Are you missing any teeth?*
YesNo

Do you see any pitting or defects on the surfaces of your teeth?*
YesNo

Are the edges of any teeth worn down, chipped or uneven?*
YesNo

Do any of your teeth appear too small, short, large or long?*
YesNo

Do you have any prior dental work that appears unnatural?*
YesNo

Do you have any crowns or bridges that appear dark at the edge of your gums?*
YesNo

Do you have any gray, black or silver (mercury) fillings in your teeth?*
YesNo

Do you have a "gummy" smile (too much of your gums show when smiling)?*
YesNo

Are your gums red, sore, puffy, bleeding or receded?*
YesNo

Does the appearance of your smile inhibit you from laughing or smiling?*
YesNo

When being photographed, do you smile with your lips closed instead of flashing a full smile?*
YesNo

Are you self-conscious about your teeth or smile?*
YesNo

Would you like to change anything about the appearance of your teeth or smile?*
YesNo

If you answered YES to ANY of the questions above, there are often several alternatives to improve your teeth and smile. To receive a personalized response to your smile analysis, please complete the form below.

You can have the smile you’ve always wanted! To schedule a FREE, no obligation office consultation, contact us today to schedule an appointment.