Please fill out these YES or NO questions to the best of your abilities.
Your smile affects your self-image, and can greatly influence the quality of your interactions with others. Many people hold back from laughing or smiling because they are uncomfortable with their smile. The following questions are designed to honestly appraise your smile. Go to a mirror, smile as wide as you can, and ask yourself the following questions (Please do not forget to include your photo):
Fields marked with an * are required
After you submit your photo, we can have it photoshopped to show you your new potential smile. Please call our office for this option!
Please Use Back Camera, Not Front Camera
Preferred DSLR camera for optimum results, or any latest iPhone or Android phone
Schedule your next visit with our highly experienced dentist.
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