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    1. What is your main concern? (check all that apply)

    Overjet (Buck teeth)
    Spaces betweeen teeth
    Crooked/ Crowded teeth
    Other (please fill in)

    2. What style of treatment would you prefer? (check your preference)

    Metal Braces
    Ceramic (Clear) Braces
    Clear Aligners

    3. Tell us why you prefer the selected style of treatment to help us meet your needs?

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