Glamour Gallery

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Your Information

Are you missing any teeth?

Yes No

What are you looking to change about your smile?

Have you had any previous cosmetic dental work?

What prompted you to look into a smile makeover at this time?

What kind of results are you looking for (multiple choice)

natural and subtle (small or minor changes) brighter (mostly color changes) straighter and more symmetrical a dramatic or overall transformation

If anything has kept you from your smile makeover, what would that be?

Do you have and major events or information about timing we should know?

Upload Close-Up of Smile & Teeth

Close-Up Photo 1

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Close-Up Photo 3

Close-Up Photo 4

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Upload Full-Face Photo (Front View)

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