Have you considered getting dental veneers before?
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Yes
No
What is your primary concern or reason for considering dental veneers?
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To correct any discoloration or staining on my teeth
To fix chipped or broken teeth
To close gaps between teeth
To reshape teeth that are irregularly shaped
To restore teeth that are worn down
To cover and protect cracked teeth
To enhance the overall symmetry and alignment of my smile
To gain confidence in my smile
To enhance my personal and professional relationships
Are you looking for a permanent solution or a temporary fix for cosmetic dental issues?
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Permanent
Temporary
Have you had any previous dental work that may affect your suitability for veneers (e.g., crowns, bridges)?
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Yes
No
Are you aware of the potential costs associated with dental veneers and are you financially prepared for this procedure?
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Yes
No
Not sure, need more information
Is there anything specific you would like to achieve or improve with your smile through the use of dental veneers?
First Name
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Last Name
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Phone
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Email
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