Smile SurveyDental Health & SmileWhat’s your biggest dental or oral health concern right now?Bleeding gumsBad breathSensitive teethGrinding or clenchingCrooked or misaligned teethStained or discoloured teethMissing teethJaw pain or clickingAnxiety about visiting the dentistI just want a general check-upHave you ever been told you have:Gum disease (gingivitis or periodontitis)High plaque or tartar levelsBite issues (overbite, underbite, crossbite)Airway concerns or mouth breathingNone of the above / Not sureAre you currently experiencing any of the following whole-body symptoms that may be connected to your oral health?Low energy or fatigueBrain fog or difficulty concentratingHeadaches or migrainesPoor sleep / snoring / mouth breathingDigestive issues or gut discomfortHormonal imbalancesSkin breakouts or rashesJoint pain or inflammationI hadn’t thought of that connection!What are your smile goals?I want a whiter, brighter smileI’d like straighter teethI want to replace missing teethI want to feel confident when I smileI’m focused more on health than looksI don’t really know — I just want adviceHave you had a dental hygiene clean in the last 6 months?YesNoAre you interested in learning how your mouth might be affecting your overall health?Yes, definitelyMaybe — I’m curiousNot right nowDo you prefer a:Holistic, preventative approachJust-fix-the-problem approachI’m not sure — I just want to feel betterIs there anything else you’d like us to know to support your dental wellness journey?Contact DetailsYour Name*Your Email*Telephone Number*Club iDYes, I would like to join Club iD and receive email updates from iDental Surgery Smile Survey Post navigation Customer Satisfaction Survey Template
