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Gum Health Check
Check the health of your gums by answering a few simple questions.
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1
Do you think your gums are swollen?
*
This field is required.
YES
NO
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2
Do you notice any bleeding when you brush your teeth?
*
This field is required.
YES
NO
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3
Do you have gaps between your teeth or gum recession?
*
This field is required.
YES
NO
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4
Do you think (or has anyone once told you) that you have bad breath?
*
This field is required.
YES
NO
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5
Do you suffer from diabetes or any heart condition?
*
This field is required.
YES
NO
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6
Do you feel that you have one or more wobbly teeth?
*
This field is required.
YES
NO
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7
Name
*
This field is required.
First Name
Last Name
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8
Email
*
This field is required.
example@example.com
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9
Phone Number
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