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Select the colour of your teeth:
1
2
3
4
5
Not sure
Choose how you look:
Straight
Spacing
Overcrowded
None of these
Do you suffer from any of the following?
Teeth cavities
Bad breath
Mouth ulcers
Yellow tongue
Bleeding gums
Painful teeth
Sensitive teeth
Wobbly teeth
Stained teeth
Gaps or spaces
Crooked teeth
Do you have any phobias or concerns?
No
Yes, please explain below:
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