1. I am concerned about the general appearance of my teeth or my smile.

2. In social situations, I am somewhat embarrassed by my teeth or my smile.

3. Which teeth would you like to fix?

4. What are your main concerns with your smile?

5. Are there any treatments you are interested in?

6. Do you know when you would like to begin treatment?

7. Budget?

Please use the space below to indicate any other problems, concerns, or questions. We will listen attentively to your concerns so that we can present you with the best possible treatment options. Thank you!