Smile Quiz

1

Who's smile are you interested in improving?* This field is required.

❤️ Family member

🙋‍♂️ I'm the patient

2

Which of these is the highest priority for improving your smile?* This field is required.

🦷 Teeth Straightened

😁 A Healthier Bite

✨ Both!

3

Which of these is the highest priority for improving their smile?* This field is required.

🦷 Teeth Straightened

😁 A Healthier Bite

✨ Both!

4

Click the image that looks closest to your smile and hit next.* This field is required.(You may choose more than 1)

5

Click the image that looks closest to their smile and hit next.* This field is required.(You may choose more than 1)

6

Which of these is the biggest motivation to seek treatment?* This field is required.

I don't like my smile

My teeth hurt

My bite feels off

I can't eat well

Other

7

Which of these is the biggest motivation to seek treatment?* This field is required.

Give them a confident smile

Their teeth hurt

Their bite feels off

They can't eat well

Other

8

ALMOST DONE! Which is MOST important when it comes to treatment?* This field is required.

Being as unnoticeable as possible

Being able to eat whatever I want

The least amount of daily responsibility in my treatment

Comfort during treatment

Quality of care provided by the orthodontist and their team

Other

9

ALMOST DONE! Which is MOST important when it comes to treatment?* This field is required.

Being as unnoticeable as possible

Being able to eat whatever they want

The least amount of daily responsibility in their treatment

Comfort during treatment

Quality of care provided by the orthodontist and their team

Other

10

Please provide your info so we can send your free report * This field is required.(We will never share your information with anyone else)

11

Please provide their info so we can send your free report * This field is required.(We will never share your information with anyone else)

12

Your Email Address* This field is required.(We will never share your information with anyone else)

example@example.com

13

Their Email Address* This field is required.(We will never share your information with anyone else)

example@example.com