Invisalign Assessment | LIC Dental Associates

Are you:

Date of birth of patient that would enter treatment:

The primary goal for treatment for the patient is: (check all that apply) Fixing an overbite/deep bite
Fixing an overjet issue
Fixing an underbite
Fixing a spacing issue
Fixing my open bite
Fixing a crowding issue
Fixing a crossbite issue
Generally straighter teeth

Tell us about the patient’s dental history - do you have or have you had any of the following? (check all that apply) Fixing an overbite/deep bite
Still has baby teeth
Currently has a bridge, fillings and/or crowns
Had braces
Currently has braces
Had teeth pulled (e.g., wisdom teeth)
Had cosmetic work done (veneers, implants, etc.)
Currently has missing teeth/gaps
Acute periodontal disease
Currently has false teeth
None of the above

When it comes to straightening your teeth, which of the following is most important to the patient? (check all that apply) Straightening teeth without anyone noticing
Minimal impact on work/school schedule with a low number of dental visits
Maintaining a healthy mouth and teeth during treatment
Continuing to eat whatever they want
Having minimal mouth and gum irritation

Does the patient have orthodontic insurance and/or access to a Flexible Spending Account (FSA)? Dental/orthodontic insurance and an FSA
Dental/orthodontic insurance
FSA
I don't know
I don't have either

How much research have you done? Just started my research
I've talked to a dentist/orthodontist about Invisalign, but haven't been evaluated yet
I've made an appointment for an Invisalign consultation with a dentist/orthodontist in the past
I'd like to set up an appointment for more information and an evaluation

If Invisalign is the right choice for the patient, I /we intend to start treatment

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Invisalign – Long Island City, NY

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