Smile Assessment Form
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Smile & Dental Health Assessment


To get started, just share a few clear photos of your teeth and answer some simple questions. Our dental team will then review your case and let you know the outcome.

After that, one of our friendly treatment coordinators will reach out, either by phone or Zoom, to guide you through the next steps.

Finally, we’ll book you in at your nearest dental practice for a full check-up, intraoral scans, and X-rays.

Take our 30-second Survey to learn if You're a Candidate.

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Your Main Concern

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Bite & Teeth Habits

Do You have a Bite Issue?

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Do You Grind Your Teeth While Sleeping?

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Oral Hygiene & Gums

Are You up to date with Your Hygiene (Cleaning) Appointments?

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Do You have any Gum Recession?

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Do You have any Wobbly / Loose Teeth?

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Orthodontic History

Have You Worn Braces in The Past?

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Are you over 18 years old?

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Upload Your Teeth Photos

Optional: Upload up to 3 photos of your teeth

Front View

Left Side

Right Side

Assessment Complete

We just need a little more information so that we can send your results.