Due to increased health concerns regarding COVID-19, we are now scheduling Virtual Consultations for new patients at our office. If you would like to schedule a virtual consultation using FaceTime or Skype, please call our office or submit the Smile Quiz below and someone from our office will contact to as soon as they can.

do or do not , there is no try check that box

Tell Us More About Your Smile Goals

Are your teeth and gums healthy?

Yes! I go to the dentist regularly, take excellent care of my teeth, and have a history of good oral health.

Mostly, yes—I brush and floss regularly, and my teeth and gums seem pretty healthy to me.

Probably not. I haven’t been to the dentist for a check-up in a long time.

I definitely have some concerns about my oral health. I am experiencing irritation, inflammation, visible decay, and/or pain.

I’m not sure.

Do you have missing teeth?

No.

Yes; I am missing 1 to 5 teeth.

Yes; I am missing more than 5 teeth.

Yes; I am missing most or all of my teeth.

What do you think about your smile?

It looks great!

I am happy with it, but there are a few small things I might want to change.

I like it, but I feel like it could certainly use some improvement.

I am unhappy with the way my smile looks.

My teeth are damaged and/or decayed and need a lot of help.

Tell us about some of your specific smile goals (check all that apply):

I want whiter, brighter teeth.

I would like to straighten misaligned or crooked teeth.

I need to replace some missing teeth.

I have cracks and chips that need to be repaired.

I want to close the gaps or spaces between my teeth.

I have a “gummy” smile and want my teeth to look more proportionate.

I want a natural-looking smile makeover.

I want a dazzling “Hollywood smile”.

First and Last Name

Email Address

Phone Number

Additional Comment (please feel free to provide more information about how you’d like to improve your smile)

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