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Smile Survey
1.
Has your social media presence made you more aware of your smile?
Yes
No
I don’t have a social media presence
2.
Have you ever detagged yourself in a Facebook photo because of your smile?
Yes
No
3.
What’s the first thing you notice when meeting someone new?
Smile
Eyes
Hair
Weight
Other
4.
Have you ever had your teeth whitened before any of these events?
Wedding
Graduation
Family photos
Other
None
5.
Which celebrity has the best smile?
Anne Hathaway
Julia Roberts
Sandra Bullock
Penelope Cruz
Carrie Underwood
Other (please specify)
6.
Which celebrity would you most like to see get a smile makeover?
Madonna
Jewel
Anna Paquin
Vanessa Paradis
Other (please specify)
7.
How many times a day do you brush your teeth?
Once
Twice
Three times
More than three times
8.
Do you floss regularly?
Yes
No
9.
How often do you rinse with mouthwash?
Never
Once a day
Twice a day
Three or more times a day
A few times a week
A few times a month
10.
How many times a year do you see your dentist?
Once
Twice
More than twice
Haven’t been in years
11.
What is your biggest smile concern?
Discoloration (yellowing, stains)
Crooked teeth
Missing teeth
Other (please specify)
12.
Which would you rather have?
Lines and wrinkles
Worn and discolored teeth
13.
Do you think a worn, discolored smile can make someone appear older than they really are?
Yes
No
14.
Would you ever consider making dietary changes to preserve your smile (i.e. stop drinking coffee)?
Yes
No
15.
Would you consider wearing orthodontics (braces/Invisalign) as an adult?
Yes, if I needed them
Yes, I have/am wearing them as an adult
No
Maybe
16.
Have you ever considered getting veneers to improve your smile?
Yes
No
Maybe
Already have them
17.
Have you ever had an in-office teeth whitening treatment?
Yes, I regularly get my teeth whitened
Yes, on occasion
Once
Never
18.
Have you ever tried at-home teeth whitening products?
Yes, I regularly use them
Yes, I have used them
Never
19.
What is your go-to at-home whitening product?
20.
What is your favorite toothpaste brand?
21.
What is one smile care topic you would love to know more about?
Veneers
Whitening
Orthodontics
Gum lift
Anti-aging smile care
Other (please specify)
22.
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