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Align Technology Survey
The results of this survey will be submitted to the local representative of Align
Technology, Inc., the manufacturers of Invisalign™.
1. Are you happy with your smile? (Circle one)
Yes
No
2. What concerns do you have about your teeth alignment? (Circle all that apply)
Crowded
Spaced
Uneven
Overjet (Buck teeth)
3. Are you familiar with the brand, Invisalign™? (Circle one)
Yes
No
Invisalign™ is a high tech orthodontic treatment that will straighten teeth without the
need for braces.
If you would like more information about Invisalign, please fill out the form below.
Name:_______________________________________________
Address______________________________________________
_____________________________________________________
email_________________________________________________
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