PERSONAL INFORMATION Full Name: Phone Number: Email Address: City & State (or country if international): Preferred contact method: Text Phone Email WhatsApp What type of treatment are you interested in? Veneers Dental Crowns Full Smile Makeover (upper + lower teeth) Not sure yet — I need guidance Are you looking for: Cosmetic improvement only (shape, color, symmetry) Functional restoration (damaged, broken, or missing teeth) Both cosmetic and functional treatment Have you had veneers or crowns before? Yes No If yes, please describe briefly (what you had done and when): Please describe your current concerns or what you would like to improve: Are you able to send clear photos of your teeth (front smile, close-up, side)? Yes, I will send photos Not at the moment Optional but highly recommended for an accurate pre-evaluation When are you hoping to begin treatment? ASAP In the next 1–2 months Just exploring for now Are you currently located in or able to travel to Los Angeles for treatment? Yes No Not sure yet Estimated budget for your smile transformation: $4,000–$8,000 $8,000–$12,000 $12,000–$20,000 From $20,000–30,000 From $30,000–50,000 I’m not sure yet “The final cost will be determined by your doctor and depends on your treatment plan.” Which matters most to you? Long-lasting materials and top-quality aesthetics A natural and subtle result Affordability and functionality A balance of quality and cost Anything else you’d like us to know? How did you hear about us? I agree to the terms of Privacy Policy Send
Skip to content 
Optimized by Seraphinite Accelerator