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1.
|
Are you satisfied with the general appearance of your teeth?
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□ Yes
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□ No
|
|
2.
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Are you satisfied with your tooth color?
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□ Yes
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□ No
|
|
3.
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Do you feel your teeth are crowded?
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□ Yes
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□ No
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4.
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Do you feel your teeth are poorly aligned?
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□ Yes
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□ No
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5.
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Do you feel your teeth are protruding?
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□Yes
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□ No
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6.
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Do you have dental caries in your front teeth?
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□ Yes
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□ No
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7.
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Do you have non-aesthetic fillings in your front teeth?
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□ Yes
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□ No
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8.
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Do you have fractures in your front teeth?
|
□ Yes
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□ No
|
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9.
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Do you wish to undergo these treatments to improve the appearance of your teeth?
| | |
| |
a. Orthodontic treatment to realign teeth
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□ Yes
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□ No
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| |
b. Tooth whitening
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□ Yes
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□ No
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| |
c. Dental crowns
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□ Yes
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□ No
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| |
d. Tooth coloured fillings
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□ Yes
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□ No
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| |
e. Dentures
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□ Yes
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□ No
|
