Smile Assessment

SMILE AS MUCH AS YOU WISH

Why do you want to straighten your teeth?

Which of your teeth is the closest to the following situation?

Show underbite malocclusion

Underbite

Show openbite malocclusion

Openbite

Show deep overbite malocclusion

Deep overbite

Show spaced teeth malocclusion

Space Teeth

Show crowded teeth malocclusion

Crowded Teeth

Show protrusion malocclusion

Protrusion

What kind of problem do you want to solve in your teeth most?

Have you ever corrected your teeth?

YES NO

How old are you?

0-10 10-16 17-35 36-50 >50

What is your gender?

MALE FEMALE
Name:
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