5673 Peachtree Dunwoody Rd. Suite 430
Atlanta, GA 30342
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404-255-9080
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in 6-12 months
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Are you a new Patient?
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Were you referred by someone? If so, who?
What is the most important factor in choosing a new dentist?
Convenience of location
Reputation and reviews
Friendly and caring staff
Comprehensive Dental services
Advanced technology and modern treatments
Inexpensive
How long have you been thinking about making changes to your smile?
Less than a month
A few months
Over a year
I've always wanted to improve my smile
I've already had my smile and not happy with the results
Want to start soon because of upcoming event
What is your primary goal for improving your smile?
Whiter Teeth
Straighter Teeth
Repair chipped or uneven teeth
Complete smile takeover
Younger Appearance
Other
What is most important to you when considering cosmetic treatment?
Improved confidence
Quick results
Long-lasting improvements
A Hollywood smile
What concerns do you have, if any, about undergoing cosmetic dental treatment?
Cost
Time Commitment
Results not meeting my expectations
Anxiety about the procedure
None
prefer most
What day of the week would you like to schedule your consultation (select all that apply)
Monday
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Thursday
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