525 Vine Street, Suite 1020, Cincinnati, Ohio 45202  |  (513) 621-2483
525 Vine Street, Suite 1020

Cosmetic Analysis

For a cosmetic analysis, simply complete the form below and someone from our dental team will contact you soon. Or we can discuss your smile with you in person at your next visit.


What do you have concerns about? (please check all that apply)

Back Teeth
Color of Teeth
Discolored Restorations (i.e. existing crowns, fillings, bonding)
Front Teeth
Gaps or Spaces between Teeth
Position of Teeth (crooked or crowded)
Shape of Teeth
Show too much Gum
Size of Teeth
Symmetry of Teeth
Teeth Chipped or Broken
Inflamed or Bleeding Gums



What do you like best about your smile?

What do you like least about your smile?

Your Name:
Telephone:
Your Email Address:
Comments or Questions:


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New Patient Offer

New Patient Offer

With an exam, X-rays and cleaning, get a Dentist-supervised take home Nite White tray bleaching system for $150, a $300 value!

Nite White tray bleaching system

Complete the form below or call our office to take advantage of this offer!

Offer Expires
09/29/2023

 

Office Hours:

  • Monday 8:00am - 5:00pm
  • Tuesday 8:00am - 5:00pm
  • Wednesday 8:00am - 5:00pm
  • Thursday 8:00am - 5:00pm
  • Friday 8:00am - 5:00pm

(513) 621-2483

* Our office does not accept any Medicaid or CareSource plans *

Office Tour Patient Forms Patient Survey Cosmetic Analysis