Smilebetter

What is bothering you about your smile ?

How many teeth show in your smile?

Are you happy with your smile?

Yes No

Describe the color of your teeth:

Are your teeth evenly colored?

Yes No

Are there any defects on your front teeth?

Yes No

Any fillings or crowns showing?

Yes No

Are your teeth crowded?

Yes No

Do you have spaces or gaps between your teeth?

Yes No

How many?

Do your gums show when you smile?

Yes No

Do you like the amount of gums that show when you smile?

Yes No

Further comments about your smile:

How would you classify your skin type?

Have you recently seen a change in your skin?

Yes No

Do you have skin pigmentation issues? (i.e.: skin discoloration, light and dark patches)

Yes No

Does your skin have acne breakout?

Yes No

If you have breakouts, which of the following do you experience?

Is your skin red and sensitive?

Yes No

Have you ever been diagnosed with a specific skin condition?

Yes No

If yes, please identify:

How many times per day do you wash your face?

Do you feel your skin is aging?

Yes No

Are there conditions and qualities that you would like to change regarding your skin?

Yes No

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Dream Face & Smile Analysis