Dr Maddahi's Spa Dentistry Smile Evaluation Quiz

In order to best help you I would greatly appreciate your thoughts and concerns regarding your smile and oral health. First please answer the following cosmetic questions and secondly your worries so I can address these for you immediately:

1.	Does your smile worry or introvert you:	Does your smile worry or introvert you: select...AlwaysOftenSometimesRarelyNever
2.	Is there anything you consider to be ugly about your smile:	Is there anything you consider to be ugly about your smile: select...I hate my smileI don't like my smileI haven't thought about itI like my smile but would like to make it betterI love my smile
3.	Do you avoid smiling when greeting others or being photographed:	Do you avoid smiling when greeting others or being photographed: select...AlwaysOftenSometimesRarelyNever
4.	Has anyone teased you about your smile or suggested you should make a change:	Has anyone teased you about your smile or suggested you should make a change: select...YesNo
5.	Have you ever wished you could have whiter teeth:	Have you ever wished you could have whiter teeth: select...YesNo
6.	Do you have any spaces between your teeth that you wish were not that way:	Do you have any spaces between your teeth that you wish were not that way: select...YesNo
7.	Do you have chips or rough edges that are unsightly and bother you:	Do you have chips or rough edges that are unsightly and bother you: select...YesNo
8.	Does your smile reveal unsightly fillings, caps, crowded, or crooked teeth:	Does your smile reveal unsightly fillings, caps, crowded, or crooked teeth: select...Yes - Unsightly fillingsYes - CapsYes - Crowded teethYes - Crooked teethYes - Two or more of these problemsNo - My smile has none of these problems
9.	Are your gums painfully obvious when you smile:	Are your gums painfully obvious when you smile: select...YesNo
10.	Would you like to improve your smile in any way:	Would you like to improve your smile in any way: select...Yes, I would!I don't think my smile can improve.

Please take a moment to choose from among the following statements about what worries or fears you may have in relation to your teeth and the treatment you've had prior to coming to Dr Maddahi.

11.

Which of the following worry you? (check all that apply)

Which of the following worry you: I am afraid of painful treatment I am afraid of dentists I have let the situation with my teeth go too long I have had a horrible experience with dental treatment I am afraid I can't afford to fix everything I need to I am embarrassed about my teeth/oral health I am worried about finding or getting to your offices

Thank you for your candid answers. I will be very happy to address these with you in person further if you want. Please feel free to contact me at any time. Thanks!
Dr. Kourosh Maddahi