Would you like your teeth to be whiter?
Do you have any gaps or spaces between your teeth?
Are any of your teeth turned, crooked, or uneven?
Are you missing any teeth?
Do you see any pitting or defects on the surfaces of your teeth?
Are the edges of any teeth worn down, chipped or uneven?
Do any of your teeth appear too small, short, large or long?
Do you have any prior dental work that appears unnatural?
Do you have any crowns or bridges that appear dark at the edge of your gums?
Do you have any gray, black or silver (mercury) fillings in your teeth?
Do you have a "gummy" smile (too much of your gums show when smiling)?
Are your gums red, sore, puffy, bleeding or receded?
Does the appearance of your smile inhibit you from laughing or smiling?
When being photographed, do you smile with your lips closed instead of flashing a full smile?
Are you self-conscious about your teeth or smile?
Would you like to change anything about the appearance of your teeth or smile?
Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.