Smile Check Up

If your smile is not what you would like it to be, we would like to help you. Let us show you how you can realize your perfect smile. Use the following Smile Checkup for your own assessment or for your discussion with Dr. Terry.

Name

Street Address

City

State

Zip Code

Phone Address

Email Address

Please check those that apply:

I wish the color of my teeth were whiter.

I wish my teeth were straighter.

I think there is too much space between some of my teeth.

I think some of my teeth are too small… or too large.

I have a missing tooth… or some missing teeth.

I think my gums show too much when I smile.

My crowns don’t match my natural teeth.

My old metallic fillings darken the appearance of my teeth.

I would like to learn more about the options available for Improving my smile.

Comments:

After completing this self-exam, you can print it out. Your check marks will remain on the print.
Whatever the results of your self-exam, there are a number of options we'd like to show you so you may realize your ideal smile. Do yourself a favor and contact our office today for a complimentary consultation with Dr. Terry. There is no charge or obligation. You will be amazed what today's dentistry, in his hands can do for you.

Phone: 770.393.1524
Email: Care@DunwoodyDentalCare.com

 

Dr. C. Terry Kim
Phone: 770.393.1524
2494 Jett Ferry Road
Suite 101
Dunwoody, GA 30338