Have you or a family member been treated for gum disease?* NO YES Do you have loose teeth?* NO YES Are your teeth sensitive to hot, cold or sweets?* NO YES Do you clench or grind your teeth?* NO YES Do you feel self conscious about the appearance of your teeth?* NO YES Do you have a dry Mouth?* NO YES Have you struggled with getting cavities?* NO YES Do you have a broken tooth?* NO YES Does your jaw hurt?* NO YES Do you cover your mouth with your hand when you smile?* NO YES Have you had a cleaning and exam in the last year* NO YES 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
