Personalised Dental Assessment
What are your main concerns about your teeth at the moment?
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Pain, sensitivity or discomfort
Broken, worn or damaged teeth
Missing teeth or gaps
Difficulty chewing or eating
The appearance of my teeth or smile
I'm not sure — I just feel something isn't right
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Personalised Dental Assessment
How long have these concerns been affecting you?
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A few weeks
Several months
Over a year
Many years
I've avoided the dentist and lost track
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Personalised Dental Assessment
How do you feel about undergoing dental treatment?
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I feel nervous and need reassurance
I feel very anxious and may need sedation
I'm okay once things are explained clearly
I've avoided treatment due to fear or embarrassment
I feel comfortable and ready to begin
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Personalised Dental Assessment
What would you like treatment to help you achieve?
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Relief from pain or discomfort
Stronger, healthier teeth
Better chewing and bite
A more confident, natural smile
A full, long‑term transformation
I'm not sure — I need guidance
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Personalised Dental Assessment
When are you looking to start treatment?
As soon as possible
In the next few months
I would just like some information for now
I'm unsure — I'd like advice
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Personalised Dental Assessment
Your Details
So we can prepare your personalised assessment
Name
*
Email
*
Phone Number
*
Preferred contact method:
Email
Phone
WhatsApp
Text message
Would you like to upload photos or X‑rays?
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Yes, I'd like to upload
Not right now
Photo Upload
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Browse Files
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Personalised Dental Assessment
Anything else you'd like us to know about your dental concerns or goals?
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