Smile Analysis

Name:
E-mail:
Are you pleased with the overall appearance of your smile?
Would you like to change anything about the appearance of your teeth or smile?
Do you have any gaps or spaces between your teeth?
Are any of your teeth turned, crooked, chipped or uneven?
Would you like your teeth to be whiter?
Are any of your teeth yellow, stained, or somewhat discolored?
Do any of your teeth appear too small, short, large or long?
Do you have any prior dental work that you are not pleased with?
Do you have any crowns or bridges that appear dark at the edge of your gums?
Do too much of your gums show when smiling?
Do your gums bleed?
Do you cover your mouth when smiling or speaking?