Clinic 1: LP Savani Main Road Adajan Gam, Surat
Clinic 2: Makkai Pool, Nanpura, Surat

1/10

1. Do you think your gums are swollen?

2/10

2. Do you notice any bleeding when you
brush your teeth?

3/10

3. Do you have gaps between your teeth and
gum recessions?

4/10

4. Do you think (or has anyone once told you)
that you have bad breath?

5/10

5. Do you suffer from diabetes or any
Heart condition?

6/10

6. Do you have a dental implant that is sore or
that bleeds when you brush it?

7/10

7. Do you feel that you have one or more wobbly teeth?

8/10

8. Are you happy with your teeth?

9/10

9. Do you have a particular spot in your mouth
where food gets trapped after a meal?

10/10

10. Do you think your teeth are crooked or
not in alignment ?