Which service will help you with your smile journey?
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Periodontics
Invisalign
Cosmetic Dentistry
Implant Dentistry
General Dentistry
Do you suffer from any of these issues?
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Bleeding Gums
Loose Teeth
Pain When Chewing
Tooth Sensitivity
Have you ever had periodontal consultation?
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Yes
No
Which of these below best describes your teeth?
Crowding
Spacing
Overbite
Underbite
Impacted Teeth
Other
Have you ever had Orthodontic treatment in the past?
No
Yes, Braces
Yes, Clear Aligners
Yes, Appliances
Are you looking for yourself or someone else?
Myself
Someone Else
What would you like to change about your smile?
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Shape
Color
Alignment
Functionality
How long have you been unhappy with your smile?
0-6 Months
6-12 Months
1-2 Years
2 Years +
Which condition best describes you?
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I have 1 tooth missing
I have multiple teeth missing
I'm missing all of my teeth or most of my teeth
I'm Struggling With Traditional Dentures
Do you currently have any of these dental solutions?
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Denture or Partial Denture
Bridge or Crown
Dental Implant
None of the above
How Ready Do You Feel To Do Something About Your Situation?
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Somewhat Ready
Very Ready
I Need Something FAST!
How long have you been suffering from your symptoms?
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0-6 Months
6-12 Months
1-2 Years
2+ Years
Do you experience any pain or discomfort in your teeth, gums, or mouth?
Yes, frequently
Occasionally
Rarely
No, never
Have you had any dental treatments or procedures in the past year?
Yes, multiple
Yes, one
No, but I need to schedule an appointment
How frequently do you visit the dentist?
Every 6 months
Once a year
Only when I'm in pain
Never
What is your name?
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What is your best email address?
*
What is your best phone number?
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