Are You Taking Care Of Your Teeth Properly?Teeth Care Questionnaire"*" indicates required fieldsStrong, healthy teeth are essential to our general health. Are you keeping your chompers in good shape?Email* Do your gums bleed?Do your gums bleed? Yes Sometimes NeverIs it painful to brush your teeth?Is it painful to brush your teeth? Yes Sometimes NeverDo your teeth hurt when eating/drinking?Do your teeth hurt when eating/drinking? Yes Sometimes NeverDo you hide your smile in pictures?Do you hide your smile in pictures? Always Sometimes NeverHow long has it been since you last visited a dentist?How long has it been since you last visited a dentist? Within the past year 1-2 years 2+ yearsCAPTCHAQuiz Score TotalQuiz PercentageQuiz GradeQuiz Pass/FailCommentsThis field is for validation purposes and should be left unchanged. Appointment Request CLINIC HOURSMonday – Thursday: 07:00 am – 04:00 pm Phone(205) 798-1780"*" indicates required fieldsName*Phone*Email Message*CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
