1. Do you like the way your teeth look?

YesNo

2. Are you happy with the color of your teeth?

YesNo

3. Would you like your teeth to be whiter?

YesNo

4. Would you like your teeth to be straighter?

YesNo

5. Do you have spaces between your teeth that you would like close?

YesNo

6. Would you like your teeth to be longer?

YesNo

7. Do you like the shape of your teeth?

YesNo

8. Do you have missing teeth that you would like to replace?

YesNo

9. Do you have old Silver fillings that you would like to replace with tooth- colored fillings?

YesNo

10. If you could change anything about your smile, what would you change?