Complete Your Smile Analysis

Are you interested in cosmetic dental treatments, but don't know where to begin? We offer a wide variety of cosmetic dental services to our Southeast (SE) Calgary patients, that can help improve the appearance of your smile! Complete your smile analysis today!

Your smile is often one of the first things people notice about you! The following questions are designed to assess your smile.

Your Smile Analysis

Using a mirror to take a closer look at your smile, and fill out the form below as accurately as possible. A member of our team will be in touch to discuss your smile restoration options with you!

Are any of your teeth yellow, stained or somewhat discolored? *

Yes

No

Would you like your teeth to be whiter?

Yes

No

Do you have any gaps or spaces between your teeth? *

Yes

No

Are any of your teeth turned, crooked, or uneven? *

Yes

No

Are you missing any teeth? *

Yes

No

Do you see any pitting or defects on the surfaces of your teeth? *

Yes

No

Are the edges of any teeth worn down, chipped or uneven? *

Yes

No

Do any of your teeth appear too small, short, large or long? *

Yes

No

Do you have any prior dental work that appears unnatural? *

Yes

No

Do you have any crowns or bridges that appear dark at the edge of your gums? *

Yes

No

Do you have any gray, black or silver (mercury) fillings in your teeth? *

Yes

No

Do you have a "gummy" smile (too much of your gums show when smiling)? *

Yes

No

Are your gums red, sore, puffy, bleeding or receded? *

Yes

No

Does the appearance of your smile inhibit you from laughing or smiling? *

Yes

No

When being photographed, do you smile with your lips closed instead of flashing a full smile? *

Yes

No

Are you self-conscious about your teeth or smile? *

Yes

No

Would you like to change anything about the appearance of your teeth or smile? *

Yes

No

---

Contact Information:

Your First Name: *

Your Last Name: *

Phone Number: *

Email Address: *

Spam Blocker

You can have the smile you’ve always wanted! Book a no-obligation office consultation today!
Request Appointment