Santa Cruz Dental Care – Free Sedation Dentistry Smile Analysis in the Santa Cruz CA area.

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Santa Cruz Dental Care
Joseph S. Valle, D.D.S

Santa Cruz Dental Care

Call (831) 423-2400

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:
(831) 423-2400

Make an Appointment

Santa Cruz Dental Care

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Dr. Joseph S. Valle

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Santa Cruz Dental Care

550 Water Street, Bldg. K-1
Santa Cruz, CA 95060

General Info: (831) 423-2400

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Call Now To Schedule an Appointment: (831) 423-2400

Call Now! (831) 423-2400

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Santa Cruz Dental Care, 550 Water Street, Bldg. K-1, Santa Cruz, California 95060 - (831) 423-2400
Dr. Joseph S. Valle

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