Smile Assessment Tool | Dulwich | The Gardens Dental Centre

Find out how you can achieve a beautiful smile with our Smile Assessment Tool …

1. Are you …

Male

Female

2. Please select your age range:

4. Do you suffer from any of the following:

Sensitive teeth

Bad breath

Mouth ulcers

Painful teeth

Stained teeth

Crooked teeth

Gaps or spaces

Bleeding gums

Wobbly teeth

5. Do you have any other concerns? Please describe below:

6. What is your reason for wanting to improve your smile?

For improved self confidence

I would like to eat with more ease

For my career reasons

For a special event

Another

If other, please specify:

7. What don't you like about your teeth?

9. Please upload a selfie to show your dentist your smile:

The uploaded image will be rendered inside the box below.

10. Your information

To receive your smile assessment results, along with a complimentary consultation with our treatment coordinator, please complete your details below:

By submitting my details, I agree to the terms and conditions detailed in the privacy policy. *