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Patient Survey

Patient Expectations Questionnaire

To help evaluate your needs and expectations as accurately as possible, please help us by answering the following questions.
Teeth: Do you feel that any of your teeth are:
Face: Are you happy with your:
Symptoms: if you want to reduce pain or discomfort, where is it located?
Please be specific about the location; check the box for the right side, left side or both
Treatment: if you had to wear orthodontic appliances would you accept that they were visible?

We will NOT use your contact details for any future marketing/promotional activities unless you consent and opt-in by ticking this box;

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