What don't you like about your smile?

Select as many boxes as you like

Missing teeth

Select

Colour

Select

Straightness

Select

Staining

Select

Bad breath

Select

Bleeding gums

Select
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What sort of smile do you want?

Select one option

Hollywood Smile

Natural Smile

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Why do you want to improve your smile?

Select as many boxes as you like

Upcoming event

Increased confidence

Enhanced aesthetics

Better functionality

Dating

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How would you rate your current smile?

Select one option

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    It needs significant help

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    I love my smile

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Would you be interested in 0% interest payment plan?

Select one option

Yes

No

Maybe

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How white is your smile?

Select one option

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    Significant staining / discolouration

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    Bright white

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Have you had any cosmetic dental treatment in the past?

Select one option

Yes, via my dentist

Yes, purchased a cheap, online kit

No

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How do your top and bottom teeth meet?

Select one option

Overbite

Normal Bite

Underbite

Edge to edge

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Do you have gaps between your teeth?

Select one option

Front teeth only

All teeth

No gaps

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Were you born with missing teeth?

Select one option

Yes

No

Don't know

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How would you best describe your crowding?

Select one option

Mild

Moderate

Severe

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Do you want your top and bottom teeth straighter?

Select one option

Just top

Just bottom

Both

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Have you undergone teeth straightening in the past?

Select one option

Yes

No

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How long have you had missing teeth?

Select one option

Less than a year

1-5 years

5 years +

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How many teeth do you have missing?

Select one option

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Where are the missing teeth located?

Select one option

Top Jaw

Bottom jaw

Both top and bottom jaw

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