Where can we send your results?

Our Treament Package

Free 30-Second Smile Assessment

To Get Our Special offer

1. Why are you thinking about straightening your teeth?

I am getting married

I am starting a new job

I want to feel more confident

I just want straight teeth

Have you worn braces or invisible aligners in the past?

Yes

No

Choose the option that best describes your biggest concern with your smile

Fix a spacing issue

Fix a crowding issue

Fix a bite problem (overbite, underbite or crossbite)

Generally crooked teeth

Of the images below, which one best describes your teeth crowding?

Mild crowding

Moderate crowding

Moderate+ crowding

Of the images below, which one best describes your teeth spacing?

Mild spacing

Moderate spacing

Moderate+ spacing

Of the following, which one best resembles your bite?

Overbite

Underbite

Crossbite

Crossbite

Of the images below, which one best describes your overbite?

Moderate overbite

Deep overbite

Protruding overbite

Of the images below, which one best describes your underbite?

Mild underbite

Moderate underbite

Moderate+ underbite

Combined underbite

Of the images below, which one best describes your crossbite?

Mild crossbite

Moderate crossbite

Moderate+ crossbite

Of the following images, which resembles your teeth most?

Mild misalignment

Mild+ misalignment

Moderate misalignment

Moderate misalignment

Moderate+ misalignment

Moderate+ misalignment

Significant misalignment

Significant misalignment

When was your most recent dental exam?

0-6 months

6 months-1 year

1-2 years

More than 2 years

Are you in need or presently getting other dental work?

Yes

No

Just cleaning

Do you have any remaining baby teeth?

Yes

No

Not sure

When do you prefer to wear your aligners?

Days only

Nights only

No preference

Do you have dental insurance covering orthodontics?

Yes

No

Not sure

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Copyright 2019 - Smiles By Design, All Rights Reserved

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Copyright 2019 - Smiles By Design, All Rights Reserved

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