Belur Orthodontics: Update on COVID-19 , LOCK DOWN 2.0

Patient Expectations Questionnaire

    Are you currently: Yes / No
    Too Small Or Short? YesNo
    Too Large Or Large? YesNo
    Crooked/Crowded Or Overlapped? YesNo
    Do You Feel You Front Teeth "Stick-Out" Too Much? YesNo
    Misshaped? YesNo
    Are There Spaces Between Your Teeth That You Do Not Like? YesNo
    Face: are you happy with your: Yes / No
    Lips YesNo
    Nose YesNo
    Jaws / Jaw Line YesNo
    Other YesNo
    Symptoms: if you want to reduce pain or discomfort, where is it located? Yes / No
    In Front Of My Ears YesNo
    INear My Ears YesNo
    Neck / Shoulders YesNo
    Temples YesNo
    Eyes YesNo
    Teeth YesNo
    Sinuses YesNo

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