1. Did you or your child experience early/late loss of baby teeth ?

 
 

2. Do you or your child have misaligned/crooked teeth ?

 
 

3. Do you or your child have trouble chewing or biting ?

 
 

4. Do you or your child have a misaligned jaw ?

 
 

5. Do you or your child have an overbite or underbite ?

 
 

6. Do you or your child have trouble cleaning or flossing your teeth due to crowding ?

 
 

7. Are you or your child self conscious about your/their smile ?

 
 

8. Do you or your child have missing adult teeth ?

 
 

9. Did your or your child’s dentist mention you should see an orthodontist ?

 
 

10. Do you or your child have speech problems ?