(770) 587-5655   |   3052 Shallowford Rd, #100, Marietta, GA 30062

New Smile Questionnaire

Use this questionnaire to help determine your feelings about your smile.

  1. What bothers you the most about your smile?

    _______________________________________________________________

  2. Are there any spaces that you do not like? Yes/No

    Is there a need for more space? Yes/No

    Is crowding a problem? Yes/No

    Explain: _______________________________________________________________

  3. (Look for esthetic problems) Ask yourself: “Does that (chip, stain, etc.) bother me?" Yes/No

    Explain: _______________________________________________________________

  4. Do you like the shape of your teeth? Yes/No

    Explain: _______________________________________________________________

  5. Do you like the way your bottom teeth and top teeth fit together? Yes/No

    Explain: _______________________________________________________________

  6. Do you have any discolored or old fillings that bother you or that you don’t like seeing when you smile? Yes/No

  7. Are your teeth as bright as you would like? Yes/No

    Explain: _______________________________________________________________

  8. How would you like your smile to look?

    _______________________________________________________________

  9. Has anyone ever shown you what you’d look like if you changed your smile? Yes/No

We Leave Lasting Impressions. Call Elite Dentistry today to schedule your appointment or consultation with Dr. Mercke. Our Marietta dental office serves Atlanta, Roswell, Woodstock, Kennesaw, Sandy Springs, and surrounding areas with personalized dentistry for distinctive elite smiles.

Smile Gallery

We invite you to browse our smile gallery for a glimpse of what we can do for your smile!

Atlanta & Company

Testimonials

“I can bite into food, chew, smile and speak without spraying!!! All the little things we take for granted. Not me and not anymore. ...Read More

We Leave Lasting Impressions. Call Elite Dentistry today to schedule your appointment or consultation with our doctors. Our Marietta dental office serves Atlanta, Roswell, Woodstock, Kennesaw, Sandy Springs, and surrounding areas with personalized dentistry for distinctive elite smiles.
3052 Shallowford Rd, #100, Marietta, GA 30062 USA
Ruth H. Clemans, DDS Marietta GA dentist (770) 587-5655 (770) 587-0608 DrClemans@AttractiveSmiles.com