Follow the steps to complete your Personal Smile Evaluation Form online.

1. Press the ‘Get Form’ button to access the Personal Smile Evaluation Form and open it in your preferred editor.
2. Begin by entering your full name in the designated field labeled 'Patient Name.' This identifies you as the individual completing the form.
3. Respond to the question regarding the appearance of your teeth and smile by selecting 'Yes' or 'No.' If you select 'No,' please provide additional details in the space provided.
4. Indicate whether your teeth are aligned by marking 'Yes' or 'No.' If 'No,' write a brief explanation to describe your concern.
5. In the section that follows, specify any issues with your teeth such as 'Chipped,' 'Protruding,' or 'Hidden' by marking the appropriate responses.
6. Answer whether you have unwanted spaces between your teeth by selecting 'Yes' or 'No.' If 'Yes,' include an explanation.
7. Next, state whether you are satisfied with the color of your teeth. Use the provided area to elaborate if your answer is 'No.'
8. Indicate if you like the shape of your teeth by selecting 'Yes' or 'No.' Provide details for further clarification if needed.
9. Respond to how your teeth come together by selecting 'Yes' or 'No,' and elaborate in the explanation section if 'No.'
10. Note any old fillings or dental work that you are unhappy with by answering 'Yes' or 'No.' Use the space for explanations if applicable.
11. Express any feelings of self-consciousness regarding your teeth and/or smile by marking 'Yes' or 'No,' and provide any further details.
12. Complete the section on previous dental care by indicating if you have had periodontal and/or orthodontic care and provide any specifics.
13. Describe how you would like your teeth to look by writing your preferences in the designated space.
14. Review the list of concerns regarding dental treatment and check all that apply to you, adding any other concerns in the space provided.
15. Upon completion, save your changes, then download, print, or share the form as needed.

Complete your Personal Smile Evaluation Form online today to help us understand your dental needs better.