Have you or a family member been treated for gum disease?*NOYESDo you have loose teeth?*NOYESAre your teeth sensitive to hot, cold or sweets?*NOYESDo you clench or grind your teeth?*NOYESDo you feel self conscious about the appearance of your teeth?*NOYESDo you have a dry Mouth?*NOYESHave you struggled with getting cavities?*NOYESDo you have a broken tooth?*NOYESDoes your jaw hurt?*NOYESDo you cover your mouth with your hand when you smile?*NOYESHave you had a cleaning and exam in the last year*NOYES It looks like you are doing a great job. Let Advance Dental Group help maintain these outstanding results. It looks like you may need some help. Let the Advance Dental Group help you get the Healthy Beautiful Smile you deserve.Name* First Last Email* Phone*Message*Best time(s) to call. Morning Noon Afternoon Evening Preferred day(s) of the week for an appointment. Any Day Monday Tuesday Wednesday Thursday Friday Saturday Evening Preferred time(s) for an appointment. Any Time Morning Noon Afternoon Evening Saturday CAPTCHA Medical History Form Dental History Form
