Light Force Smile Survey

See if you’re a candidate for LightForce braces.

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1

I am:

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2

Which image best describes your smile?

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3

What would you like to learn more about? (select all that apply)

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4

Have you had orthodontic treatment before?

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5

First Name:

This field is required.
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Last Name:

This field is required.
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7

Date of Birth:

This field is required.
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Zip Code:

This field is required.
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9

Email:

This field is required.
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10

Phone Number:

This field is required.

The LightForce Smile Survey does not replace the need for a consultation with an orthodontist or dentist, as only a trained LightForce Orthodontic System provider can determine if you are a good candidate for LightForce braces. Please consult your doctor to determine if LightForce braces are right for you. The LightForce Smile Survey is open only to prospective users who are at least thirteen (13) years old at the time of the survey.  Respondents who are not the legal age of majority in his/her jurisdiction of residence (in the case of Alabama, this means less than 19 years of age; in the case of Mississippi, this means less than 21 years of age; in the case of Nebraska, this means less than 19 years of age or upon marriage) must have a parent or guardian’s permission to participate and to provide personal information.