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Corporate Entry
This section is intended for corporate clients or those interested in corporate information.
 

Life Time Smiles
Level 17, 141 Queen Street
Brisbane Q 4000
Phone: 07 3221 7273
Fax: 07 3210 0215

Questions & Answers

   
Company
Name*
Address
Zip/City
Phone*
Email*
* mandatory
Reply by* Email   Phone   Post
 
Gum Health Section
Do you feel your gums are:
Healthy and well maintained
Not as good as they could be
Affected by gum disease

Do you suffer from one or more of the following:
Bad breath
Longer teeth than other people
Mobile teeth
Gum recession
Tooth loss due to gum disease

Have you recieved treatment from a periodontist before?
Yes
No

Do your gums bleed when you clean your teeth?
Yes
No

Do you clean your teeth:
Three times a day
Twice a day
Once a day
Less than once a day

Do you clean between your teeth with floss, flossettes, interproximal brushes:
Three times a day
Twice a day
Once a day
Less than once a day
Never

Do you use a mouth wash or mouth rinse:
Three times a day
Twice a day
Once a day
Less than once a day
Never

 

 
o www.lifetimesmiles.com.au o Online Contact Form o Phone 1300 661 053