Smile Survey

After answering the following 6 questions we will be able to determine if Gilsdorf’s Orthodontics will be able to help you get the smile you have only dreamed about.

Describe Yourself

A teen considering Invisalign teenAn adult considering Invisalign treatmentA parent considering Invisalign teen treatment for your teenA bride or groom-to-be considering Invisalign treatmentA patient already in treatment from another doctor

What is your age group?

14-1718-2930-4445-5960+

Choose the option that best describes your biggest concern with your smile

Fix spacing issuesFix a crowding issueFix a bite problem (overbite, underbite or crossbite)Generally straighter teeth

Of the images below, which one best describes your teeth crowding?

Mild SpacingModerate SpacingExtreme Crowding

Of the images below, which one best describes your teeth spacing?

Extreme IssuesOver biteSpacing Issues

Do you have orthodontic insurance and or / access to a Flexible Spending Account (FSA)?

Yes, I have dental/orthodontic insuranceYes, I have an FSAYes, I have dental/orthodontics insurance and an FSAI don’t have eitherI don’t know

What is the best way to contact you with your results?

Please leave this field empty.