The Institute Of Dentistry – Free Wisdom Teeth Smile Analysis in the Riverside CA area.

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:

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:

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Call for an appointment:
(800) 334-2057

Make an Appointment

The Institute Of Dentistry

Dr. Orest Frangopol

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The Institute Of Dentistry

14437 Meridian Parkway
Riverside, CA 92508

General Info: (800) 334-2057

Make Appointment Map & Hours Email the Doctor Tell a Friend

Comfortable, Affordable Care

Smile Analysis Questionnaire

Call for an appointment:(800) 334-2057

Dr. Orest Frangopol

Call for an appointment:
(800) 334-2057