Am I a candidate for professional whitening?

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We love inspiring healthy + confident smiles!

We love inspiring healthy + confident smiles!

Let's find out if you're a candidate for professional teeth whitening...

13Questions

1
Name
First Name
Last Name
2
Email
example@example.com
3
Phone Number
Area Code
Phone Number
4
Birthdate
Date
Year
Month
Day
5
Approximately how long since your last check up with a dentist?
6
Approximately how long since your last dental cleaning?
7
On a day to day basis, how sensitive are your teeth?
Not sensitive at all.
A little sensitive.
Moderately sensitive.
Very sensitive.
Not sensitive at all.
A little sensitive.
Moderately sensitive.
Very sensitive.
8
Have you used any professional or over the counter whitening products in the past? Examples: professional in office whitening, custom whitening trays+gel, another Wicked White product, whitening at a spa, Crest White Strips, whitening toothpaste....
Huge
Large
Normal
Small
Ok
Ok
9
To the best of your knowledge, do you have any fillings, crowns or veneers on your front teeth (the ones visible when you smile)?
Yes
No
Unsure
10
Are you currently breastfeeding or pregnant?
Yes
No
Unsure
11
Do you have loose teeth or red/swollen gums?
Yes
No
Unsure
12
Do you have any gum recession on the teeth that are visible when you smile?
Yes
No
Unsure
13
Do you have any questions about our whitening products or services?
Huge
Large
Normal
Small
Ok
Ok
14
Tags
[object Object]
Should be Empty:

Question Label

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