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Smile Direct Club Survey Questions


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Smile Direct Club Survey Questions during the intake process

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Smile Direct Club Survey Questions

  1. 1. Before we can review your photo assessment, please answer the following dental, health and history questions: Yes or No If yes, please provide details I have a bonded retainer: I have bridgework: I have crowns: I have an impacted tooth: I have an implant: I have primary (baby) teeth: I have veneers: Do you feel pain in any of your teeth?: Do you have any sores or lumps in or near your mouth?: Do you currently have any head, neck, or jaw injuries?: Do you currently experience: jaw clicking, pain, difficulty opening and/or closing or difficulty chewing?: Have you noticed any loosening of your teeth or do you have untreated periodontal disease?: Do you have any known allergies to any dental materials?: I have a history of IV bisphosphonate treatment.: I am currently on acute corticosteroids or in immunosuppression, chemotherapy, or radiation of head/neck.: I have had a bone marrow transplant or treatment of hematological malignancies (blood cancers) within the past 2 years.: Once we have received this information, we will review it and get back to you in case we need further details.