Mark the statements below with your best answer and we will let you know if you're a good candidate for Six Month Braces.
1. You are frustrated by crooked teeth and are overdue for a positive change
*
Yes
Sometimes
Rarely
Never
2. Your confidence is affected by the way you smile in public
*
Yes
Sometimes
Rarely
Never
3. Your social life is affected by the appearance of your teeth
*
Yes
Sometimes
Rarely
Never
4. You want to keep your teeth for life and realize that straight teeth last longer
*
Yes
No
I don't care
5. Price is important but you believe quality is even more important
*
Yes
Sometimes
Rarely
Never
6. You would like to have straight teeth in the shortest amount of time possible
*
Yes
No
I don't care
7. Dentists are skilled and trusted health care providers
*
Yes
Sometimes
Rarely
Never
Name
*
First
Last
Email
*
Phone
*