Invisalign / ART (arch reformulation therapy): Questionnaire
1. I am:
An adult considering Invisalign / Arch Reformulation Therapy (ART)
A teen considering Invisalign / ART
An adult considering Invisalign / ART for my child
2. Which best describes the orthodontic therapy / ART you've had in the past:
Invisalign - orthodontic aligners
Never had orthodontic treatment
Orthodontic aligners - non-Invisalign
2a. If you've experienced dental braces relapse - when did you first become aware of the problem?
less than 1 year
never had orthodontic therapy
never had any dental braces relapse
my teeth have shifted, but I've never had orthodontic therapy
3. Do you have all of your adult teeth (except for wisdom teeth)?
4. What do you hope to achieve from ART (Arch Reformulation Therapy)?
Healthier gums and bone
More even bite
Reduce the overbite
Make brushing easier
Make flossing easier
Reduce staining and plaque buildup
Improve my smile
Improve my profile
none of the above
5. How many times per day do you brush?
3 or more
less than 1
6. How many times per day do you floss?
2 or more
7. Which statement(s) do you agree with?
A healthy mouth is an important part of my overall health.
A beautiful smile is very important to me.
My primary goal is to have straight teeth, but, general dental health is important, too.
My primary goal is to have excellent dental health
None of the above
8. Do you have any orthodontic insurance coverage?
I don't know
9. Can you benefit from a health savings account (HSA) flexible spending account (FSA)?
I don't know
10. If everything works out, when would you like to start ART?
In the next month
In the next 6 months
As soon as I can arrange the finances
Not sure yet
11. How much research have you done?
Spoke with my dentist about Invisalign but have not had an evaluation
Have an appointment scheduled for an evaluation
Had an Invisalign consultation and would like a second opinion
Ready to schedule an appointment to start Invisalign - ART treatment
12. Have you ever been told that you were not a candidate for Invisalign?
13. If you have had an Invisalign specific consultation, was your treatment classified as:
I haven't had an Invisalign consultation
I was told I couldn't have Invisalign
14. Would you be opposed to having your teeth whitened by an oral antiseptic agent during the therapy?
Please Submit to Dr. Davis
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