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1. Is this for you or someone else?

Myself

Someone else

2. What's your age?

Under 12 years old

12-17 years old

18-24 years old

25-34 years old

35-44 years old

45 years old and above

3. Have you had orthodontic treatment before?

Yes

4. What orthodontic procedure are you interested in?

Invisalign

Dental Braces

Whatever the dentist advises

Click the option that best describes the state of your teeth

Crooked

Overbite

Big Gaps / Spaced Out

Crowding

How would you describe the condition of your teeth and smile?

Minor cosmetic concerns

Alignment or spacing concerns; fair oral health

Significant dental problems; less-than-ideal oral health

What is your time frame to fix your teeth?

Less than 6 months

6 months to 1 year

1 to 2 years

Over 2 years

Why now? What made you take the step now?

I want to improve my appearance

I have experienced discomfort or pain

I received a referral or recommendation

I'm looking to boost my confidence

If we need to fit this into your budget, how can we make it affordable for you?

Monthly payment plans

Flexible treatment options

Assistance with dental benefits

Referral credit for bringing new patients

Fabulous Dentistry

9863 Long Point Rd Houston Tx 77055

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