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A Smile Makeover, also known as a "Custom Smile Design", is easy, painless and can change your entire appearance overnight!

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Please complete the form below and we will get back to you shortly with your free Smile Analysis:
1. Name: *  
2. Your Age: *
3. Email Address: *
4. City: *
5. State: *
6. How many teeth do you show with
your best smile?
  
7. Do my teeth seem too dark.
 Yes    No  
8. How would you describe their color
and shade?
  
9. How are color and shade distributed?
Even    Uneven  
10. Do you have white or discolored
spots on your teeth?
 Yes    No  
11. Do you see any pitting or defects
on the surface of your teeth?
 Yes    No  
12. Do your front teeth have any
visible fillings and/or crowns?
 Yes    No  
13. Are your teeth crowded?
 Yes    No  
14. What shape and size do your
teeth have?

Please choose one value per the
corresponding section of your mouth.
  
15. I see significant differences
between neighboring teeth.
Yes    No  
16. I show my gums when I smile.
 Yes    No  
17. I like the amount of gums
that I show.
 Yes    No  
18. How would you describe your lips?
 
19. Is there anything you would like to mention about your smile?
20. How did you hear about us?
  
Please click the Submit Button
and we will get back to you shortly
with your free Smile Analysis!
 *Required Fields
 
 
 
Cosmetic Enhancement Center     7952 Jericho Turnpike, Woodbury, NY 11797     Telephone: 516-496-8101
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