HAPPY SMILES
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Terms & Conditions
Smile Assessment Form
Take the first step towards a confident smile by completing our smile assessment form. Our team will review your information and contact you to discuss your treatment options.
Full Name
Email
Phone Number
How old are you or the person you are inquiring about? (for age-specific treatment options).
What is your smile transformation goal?
Gain confidence and straighter teeth
Fix a spacing/gap issue.
Fix a crowding issue.
Fix a bite problem.
Fix breathing issues.
Have you worn braces or invisible aligners in the past?
Yes
No
Which smile looks similar to yours/your child's?
Cosmetic
Cross Bite
Crowded
Gapped
Open Bite
Over Bite
Under Bite
What’s your biggest question about treatment?
Can I afford it?
How long does it take?
What will the end results look like?
Do I have time to complete treatment?
Where are you in your journey for a new smile?
We just started our research and I have questions.
The dentist said braces were needed and now looking for the right orthodontist.
Ready to get started.
Are you interested in specific treatments like Invisalign, braces, or other options?
Any optional comments you would like to share about your smile or treatment preferences.
I Agree with the
Terms and Conditions
of the Happy Smiles Dental Clinic.
Submit
Form