Aligner Candidacy Quiz

Name *

Phone

Email *

What is the primary reason you are interested in Invisalign?
Straightening my teethClosing a space or spaces between my teethEliminating crowding or overlap in my smileGetting my top teeth and lower teeth to function better

Other

Is there anything else about your smile you would like to improve?
YesNo

If yes, please tell us more:

Have you ever had orthodontic treatment before?
YesNo

How old are you?

What questions or concerns do you have about starting treatment? (you may select more than one answer)
How much will it cost?Will it hurt?How often do I have to go to the dentist during treatment?Are there other options that are better or less expensive?

Other

Where are you in the process of making a decision?
I am just starting to look around and check-out my options.I am doing research for a loved one.There is a special event motivating me to get a “perfect” smile.I have met with other dentists and am looking for a 2nd opinion.I am ready to get started now.

Choose Location *
—Please choose an option—WindermereLake Nona

Have you had an exam with x-rays in the last year?
YesNo