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Am I A Candidate?
(30 sec survey)
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What is your main reason for achieving a better smile?
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General Improvement
Causes Discomfort
Upcoming Event (ex: wedding, graduation, ect.)
Lack of Confidence
Tell us a bit more about your teeth...
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Crooked Teeth
Cross Bite
Gap Teeth
Open Bite
Over Bite
Under Bite
Generally Straight Teeth
Mix Of Baby And Adult Teeth
How old are you?
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Under 14
Teen 14 - 17
Adult 18 - 25
Adult 25 - 35
Adult 45+
How soon are you looking to get started?
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Right away
A few weeks
A few months
Have you ever worn clear aligners or braces before?
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Yes; Clear aligners
Yes; Braces
No
Do you have a permanent retainer?
Yes
No
Do you have any pre-existing dental work?
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No
I have some bridge work
I am missing some teeth
Other
Do you have dental insurance? (save up to $1300 on aligners)
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Yes
No
What kind of insurance do you have? (you may choose more than one)
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Dental Insurance
Flexible Spending Account (FSA)
Health Reimbursement Account (HRA)
Health Savings Account (HSA)
No Insurance (No Problem)
Would you be interested in an affordable payment plan?
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Yes, Please!
No, Thanks.
How did you hear about us?
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Facebook
Google search
Instagram
Referral (from friends & family)
Referral (from a dentist)
Name
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First
Last
Email
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Please enter your email, so we can follow up with you.
Contact Number
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Zip Code
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I am a...
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Female
Male
I prefer not to say
Promo Code
Here are your options to get started:
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FREE Virtual Consultation
Book a FREE In-Office Scan
1295 West Spring Street #210 Smyrna, GA 30080 | You will receive a follow-up email with instructions on how to prepare for your appointment. (Our office is following ADA, CDC, and OSHA health and safety guidelines for COVID-19.
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