call us on
0116 2891317
Email Us
|
Request Call Back
|
Read our Blog
Home
About You
About Us
Treatments
Testimonials
Fees
Contact
Overview
New Patients
Your Smile
Caring for You
Ask the Dentist
Why Choose Us?
Photo Gallery
Meet The Team
Promises & Expectations
Standards
Cosmetic
Smile Makeovers
Teeth Whitening
Porcelain Veneers
White Fillings
Metal free crowns
Gum Contouring and Teeth Reshaping
Cosmetic Dentures
Restorative
Broken Teeth
Crowns & Bridges
Dentures
Preventive
Children
Sports Mouthguards
Dental Hygiene
Bad Breath
Gum Disease
Decay Detection
Mouth Cancer Screening
General
Oral Surgery
Root Canal Treatment
Facial
What Our Patients Say
Letters from Phobic Patients
Fee Guide
Membership Plan
Financial Arrangements
Offers of the Month
Appointment
Location
Emergencies
New Patients
Email Us
News
FAQs
Overview
New Patients
Your Smile
Caring for You
Ask the Dentist
About You
»
Your Smile
We want to meet your needs and can help with all the following issues. Please
√
any that concern you and hand this form to a member of the team.
I am self-conscious about my teeth when I smile.
My gums bleed when I brush my teeth and I get a bad taste in my mouth.
My teeth are not as bright and white as I would like them to be.
My teeth are sensitive.
I am unhappy about the colour of my crowns or fillings.
My dentures feel uncomfortable.
Some of my teeth are dark, chipped or misshapen.
I am worried about the cost of treatment and how to pay for it.
I have some missing teeth which affect my smile.
On a scale of 1-10 (10 being best), I would rate my smile
Name
Date
Email
Telephone
Verify