Smileperfect US - Assessment Form

1Let's learn about your smile! Which word would you use to describe your teeth? *

Crowding

Spacing

Protruding

2 Are you 18 or older? *

Yes

3 How severe is the problem? *

Mild

Medium

Severe

4 Do any of the following conditions apply to you? *

I have dental implants

I have missing teeth

I have unfilled cavities

I have swollen or inflamed gums

None

5Have you worn braces or other invisible aligners in the past? *

Yes

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