Smile Analysis Lead

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.

5

Click the image that looks closest to their smile and hit next.* This field is required.

6

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

Give them a confident smile

Their bite feels off

They can't eat well

Mouth breathing

Oral Habits

Other

7

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

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 they want

The least amount of daily responsibility in their treatment

Other

9

Please provide your info so we can send your free report * This field is required.

10

Please provide their info so we can send your free report * This field is required.

11

Your Email Address* This field is required.Email Address

example@example.com

12

Their Email Address* This field is required.Email Address

example@example.com

13

Tell us how we did!Please rate your experience with our Smile Assessment and don't forget to schedule your complimentary consultation by hitting our "Book Now" feature on our webpage!