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K3 Dental 5 minute Smile Check

K3 Dental 5 minute Smile Check

This is the first step to improving your smile :) This form will give us a good idea of your needs so we can advise you on possible treatments. We offer FREE consultations at our practice in Leicester on Saturdays.
14Questions
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    Yes - I have gaps
    No gaps
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  • 4
    Ideally, your top and bottom teeth should align perfectly with each other  
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    Not at all symmetrical
    Yes - perfect symmetry!
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  • 5
    If you drew an imaginary line down the middle of your face, would there be a mirror image on each side?
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    Not symmetrical
    Yes - perfect symmetry!
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  • 6
    Are your teeth in proportion? 
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    My teeth stick out a lot
    No - teeth do not stick out at all
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  • 7
    Our periodontist is able to help with any dental hygiene and gum disease
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  • 9
    e.g. any special requirements or specific questions?
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    Ok
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  • 11
    If you would like us to contact you by email in the future
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  • 12
    Upload up to 5 photos (10mb file size limit which should be plenty for most photos)
    Drag and drop files here
    Select files to upload
    Max. file size: 10.3MB
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  • 13
    This is required so we can get in touch with you
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  • 14
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