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1604 Lakeland Ave, Bohemia, NY 11716
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(631) 567-5566
Request
a Free Consultation
Smile Makeover Assessment
Do you usually brush your teeth at least twice a day?
Yes, usually brush twice per day
No, usually only once a day
None of the above
Do you currently have dental insurance?
Yes
No
Have you ever had your teeth professionally whitened?
Yes
No
As far as you know, do you currently have any cavities or gum disease?
Yes
No
When was your last dental visit?
1 - 6 months
6 - 12 months
Over a year ago
Do You Find Yourself Hiding Your Smile In Public?
Yes
No
If you had to pick one, what issue are you most hoping we can help with?
Discolored teeth
Crooked or crowded smile
Chipped or broken teeth
Gummy smile
Gaps in smile
Something else
Is There Anything Keeping You from Enhancinging Your Smile?
No! I’m ready to fix my smile today
Cost of treatment
Fear of the dentist
Time commitment
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