Smile Analysis Questionnaire

"A smile costs nothing, but gives much. It enriches those who receive, without making poorer those who give. It takes but a moment, but the memory of it sometimes lasts forever. None is so rich or mighty that he can get along without it, and none is so poor but that he can be made rich by it. A smile creates happiness in the home, fosters good will in business, and is the countersign of friendship. It brings rest to the weary, cheer to the discouraged, sunshine to the sad, and is nature's best antidote for trouble. Yet it cannot be bought, begged, borrowed, or stolen, for it is something that is of no value to anyone until it is given away. Some people are too tired to give you a smile. Give them one of yours, as none needs a smile so much as he who has no more to give."

Believed to be from the writings of Rabbi Raphael Samson Hirsch

If you had unlimited resources, what would you change about your SMILE?


When you meet someone for the first time, what do you usually notice more?
Eyes
Smile
Other
If you could have a Brighter, Whiter, Healthier looking smile, do you feel it would affect other parts of your LIFE?

Do your gums feel healthy when you brush and/or floss your teeth? Yes No

Do you ever experience bleeding when brushing or flossing?
Yes
No
Do you frequently find it necessary to use breath fresheners or mouth rinses to keep your breath feeling fresh?
Yes
No
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