Smile Evaluation

A simple Evaluation to Help You Obtain the Smile You’ve Always Wanted


Hold a mirror 12"–14" from your face. Smile to show your teeth. Take the time to observe your teeth carefully, and then answer the following questions:



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9070 E Desert Cove Ave #105
Scottsdale, AZ 85260

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Smile Evaluation

A simple Evaluation to Help You Obtain the Smile You’ve Always Wanted


Hold a mirror 12"–14" from your face. Smile to show your teeth. Take the time to observe your teeth carefully, and then answer the following questions:


1. Do you like the appearance of your teeth and your smile? YesNo
If not, explain
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2. Are your teeth all in alignment (straight)? YesNo
If not, explain
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3. Do you have spaces that you don’t like? YesNo
If yes, explain
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4. Do you like the color of your teeth? YesNo
If not, explain
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5. Do you like the shape of your teeth? YesNo
If not, explain
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9070 E Desert Cove Ave #105
Scottsdale, AZ 85260

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Smile Evaluation

A simple Evaluation to Help You Obtain the Smile You’ve Always Wanted


Hold a mirror 12"–14" from your face. Smile to show your teeth. Take the time to observe your teeth carefully, and then answer the following questions:


6. Are your teeth…
Chipped YesNo
Protruding YesNo
Hidden YesNo
If yes, explain
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7. Are your teeth wearing on the biting surfaces? YesNo
If yes, explain
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8. Are there old fillings or dental work you don’t like looking at? YesNo
If yes, explain
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9. What would you like to change the most in the appearance of your teeth?
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10. How would you like your teeth to look?
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9070 E Desert Cove Ave #105
Scottsdale, AZ 85260

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