Dr. Christopher Bakke’s Free Sedation Dentistry Smile Analysis in the Marietta GA area.

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Implant & Family Dentistry

Implant & Family Dentistry

Call (770) 973-4214

Free Smile Analysis

If you are 18 years old or older, we would be pleased to provide you with a free smile analysis.

Please provide us with the following information and a member of our staff will contact you soon to schedule an appointment.

Smile Analysis Questionnaire

*First name:

*Last name:

*Phone:

*Email:

*ZIP/Postal Code:

How many teeth show in your smile?

Are you happy with your smile?

Yes No

Describe the color of your teeth:

very white
off white
yellow
dark yellow
grey

Are your teeth evenly colored?

Yes No

Are there any defects on your front teeth?

Yes No

Any fillings or crowns showing?

Yes No

Are your teeth crowded?

Yes No

Do you have spaces or gaps between your teeth?

Yes No

How many?

Do your gums show when you smile?

Yes No

Do you like the amount of gums that show when you smile?

Yes No

Further comments about your smile:

Call for an appointment:
(770) 973-4214

Make an Appointment

Implant & Family Dentistry

Dr. Christopher Bakke

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Implant & Family Dentistry

1735 Roswell Rd. Bldg #200
Marietta, GA 30062

General Info: (770) 973-4214

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Call Now To Schedule an Appointment: (770) 973-4214

Call Now! (770) 973-4214

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Implant & Family Dentistry, 1735 Roswell Rd. Bldg #200, Marietta, Georgia 30062 - (770) 973-4214
Dr. Christopher Bakke

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