Preliminary Screening Name First Last PhoneEmail Have you had any previous cosmetic dental work?*YesNoMaybeVeneers, bonding, bridges, implants, crowns, etc...Has a dentist ever asked you to consider orthodontics?*YesNoMaybeMetal braces, ceramic braces, self-ligating braces, clear aligners, etc...Do you have any missing teeth, or any condition causing the loss of teeth?*YesNoMaybe
