Which service will help you with your smile journey?

*

Periodontics

Invisalign

Cosmetic Dentistry

Implant Dentistry

General Dentistry

Do you suffer from any of these issues? *

Bleeding Gums

Loose Teeth

Pain When Chewing

Tooth Sensitivity

Have you ever had periodontal consultation? *

Yes

No

Which of these below best describes your teeth? *

Crowding

Spacing

Overbite

Underbite

Impacted Teeth

Other

Have you ever had Orthodontic treatment in the past? *

No

Yes, Braces

Yes, Clear Aligners

Yes, Appliances

Are you looking for yourself or someone else? *

Myself

Someone Else

What would you like to change about your smile? *

Shape

Color

Alignment

Functionality

How long have you been unhappy with your smile? *

0-6 Months

6-12 Months

1-2 Years

2 Years +

Which condition best describes you? *

I have 1 tooth missing

I have multiple teeth missing

I'm missing all of my teeth or most of my teeth

I'm Struggling With Traditional Dentures

Do you currently have any of these dental solutions? *

Denture or Partial Denture

Bridge or Crown

Dental Implant

None of the above

How Ready Do You Feel To Do Something About Your Situation? *

Somewhat Ready

Very Ready

I Need Something FAST!

How long have you been suffering from your symptoms? *

0-6 Months

6-12 Months

1-2 Years

2+ Years

Do you experience any pain or discomfort in your teeth, gums, or mouth? *

Yes, frequently

Occasionally

Rarely

No, never

Have you had any dental treatments or procedures in the past year? *

Yes, multiple

Yes, one

No, but I need to schedule an appointment

How frequently do you visit the dentist? *

Every 6 months

Once a year

Only when I'm in pain

Never

What is your name? *

What is your best email address? *

What is your best phone number? *