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7510 State Line Rd. Suite C,
Prairie Village, KS 66208
Call or Text! (913) 901-8585

YOUR SMILE SURVEY

A SIMPLE EVALUATION TO HELP YOU OBTAIN THE SMILE YOU’VE ALWAYS WANTED

Answer these few questions as honestly as you can. Have them at hand when you talk to your dentist. They’ll help you find out how
Lumineers can give you a beautiful, white smile—the one you’ve always wanted—in just 2 easy dentist visits!

    Do you like the appearance of your smile?

    Do you like the appearance of your teeth?

    Do you like the color of your teeth?

    Do you have spaces between your teeth that you don’t like?

    Do you like the size and shape of your teeth?

    Are there old fillings or dental work you don’t like looking at?

    What would you like to change the most about the appearance of your teeth?

    7510 State Line Rd. Suite C,
    Prairie Village, KS 66208
    (913) 901-8585