204-206 Krupal Pathshala, Shivranjini Cross Roads, Ahmedabad - 380015
+91 7567412412
theparikhsclinic@gmail.com
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Smile Now
1. Select Your Smile
1. Are You ?
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Male
Female
2. Are You ?
*
Teen
Adult
3. Not Happy with?
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Size of The Teeth
Shape of The Teeth
Color of The Teeth
Shade of The Teeth
Teeth Crowding
Alignment of Teeth
4. Any Problem if you are Facing?
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Crowding
Space between teeth
Cross bite
Deep bite
5. Do you feel low Confidence when you smile?
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Yes
No
6. Do You Feel Conscious about your Breath?
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Yes
No
7. Do you Feel Conscious when you get Clicked?
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Yes
No
8. Upload a Selfie or a Smiling Picture for our Assessment :
*
2. Personal Detail
First Name
Last Name
Email
Phone Number
Country
Select Country
India
United States
United Kingdom
Canada
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State
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Gujarat
Maharashtra
Delhi
City
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Ahmedabad
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