Your Smile Questionnaire

Your Name
Date

In order to evaluate your needs and expectations as accurately as possible, please help us by answering the following questions:

Do you feel that your teeth are:

Too small or short?

Too large or long?

Crooked or crowded?

Misshaped (uneven/pointed)?

Off Colour?

Do you feel your front teeth "stick out too much" ("Buck Teeth)?

Are there spaces between your teeth that you do not like?

ls there too much or too little gum tissue showing when you smile?

Has there been previous orthodontic treatment (including braces or other
appliances)?

lf so, when and by whom?

Are there other dental issues not listed above that you would like to discuss or have treated?

If yes, please give details

8/3 Rosewood Drive

Rural View, Mackay 4740

(07) 4840 2832

Call us today!

Opening Hours

Mon - Fri: 8:00 - 17:00