COSMETIC / AESTHETIC EVALUATION

We respect your right to choose the level of care that fits your needs. We’ve found that many adults are unaware that problems even exist. There are rarely symptoms associated with the aging and deterioration of teeth and gums ­until it is far too late. According to the ADA, more than 80% of adult Americans have some level of gum disease. With your permission we would like to explain the choices available to achieve long-term health and beauty for your teeth.

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Please Check all that apply: I desire to keep my own teeth for life. I want my teeth to look good, feel good, and last for a long time. My teeth are a major priority for me and would like to get started as soon as possible. Spreading payments out over time may help me to achieve the excellent results I desire. Phasing treatment, by priority, over a time may make it feasible for me to achieve the excellent results I desire. Please indicate if any of the following items apply to you: Do you have any fillings in your front teeth? Do you have any cracked teeth? Do you have teeth with extensive wear? Do you have receding gums? Do you gums bleed when brushing or flossing? Do you have any sores in your mouth? Are your teeth discolored due to trauma, endodontics or as a result of antibiotics? Do you drink: (check) Tea,  Coffee, Dark Soft Drinks,  Red Wine Do you have a strong gag reflex?

Are you delighted with your smile? Please Select Yes No Please rate your smile from 1 to 10 (1=I hate my smile, 10=awesome) Please Select 1 2 3 4 5 6 7 8 9 10 Would you like to have whiter teeth? Yes No If you had a magic wand what, if anything, would you change about your smile? What (if any) personal or professional benefit might you gain if you had a gorgeous smile? Do you have any special occasions coming up?

At Overton Center of Dental Arts, P.C., though our focus is on appearance-related dentistry, we deliver full-service dentistry as well. With flexible payment plans as well as phasing treatment over time, you can achieve spectacular long-term results. Thank you so much for the opportunity to be of service.

Health and Happiness,
Dr. Tom Overton and Team