Smile Assessment Tool

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Creating beautiful smiles

Find out how you can achieve a beautiful smile with our
Smile Assessment Tool...

1. Are you...*

Male

Female

2. Please select your age range:*

18-24

25-34

35-44

45-54

55-64

65+

3. How would you rate your smile?*

1

2

3

4

5

6

7

8

9

10

4. Do you suffer from any of the following:*

Sensitive teeth

Bad breath

Mouth ulcers

Yellow tongue

Painful teeth

Stained teeth

Crooked teeth

Gaps or spaces

Bleeding gums

Wobbly teeth

5. Do you have any other concerns? Please describe below:

6. What is your reason for wanting to improve your smile?*

For improved self confidence

I would like to eat with more ease

For my career reasons

For a special event

Another

If other please specify:

7. What don't you like about your teeth?*

8. The treatment I am interested in is:*

Whiter teeth

Repair chipped teeth

Close spaces and gaps

Replace old dental treatment

Tooth coloured fillings

Straighter teeth

Replace missing teeth

Stabilise my denture

Replace wobbly & loose teeth

Help with my eating

Remove stains

Treat bleeding gums

Another reason

If other, please specify:

8. Please upload a selfie to show your dentist your smile:

Choose file

Choose file

The image uploaded will be rendered inside the box below.

RESULTS!

To receive your smile assessment results, along with a complimentary consultation with our treatment coordinator, please complete your details below:

Smile Works Dental is the leading name where our dentists try to deal with all your oral needs and treat them with confidence. Our dentists have already treated many complicated cases in the past by using the most advanced form of dentistry.

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Contact Info

Email:

[email protected]
Address:

Smile Works Dental,
Suite 1, 20 Wimpole Street,
London, W1G 8GF – Near Harley Street, London

Telephone:

020 71834091
Opening Hours:

Mon - Thu : 8:00am - 8:00pm
Fri : 8:00am - 6:00pm
Sat - Sun : 10:00am - 5:00pm

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