How often do you drink wine?
*
Every day
A few times a week
Once a week
Rarely
Never
What's your current toothbrush?
*
manual toothbrush
It's an electric toothbrush
it's battery-powered
What products make up your oral care routine?
Floss
Toothpaste
Whitening Treatments
Mouthwash
Water Flosser
Do your teeth seem to be thinning?
*
Yes
No
Do your gums need extra care?
*
Yes
No
Have you used braces, aligners, or other orthodontics?
*
Yes
No
Do you smoke?
*
Yes
No
Are your teeth sensitive to hot or cold?
*
Yes
No
What kind of toothpaste do you use?
*
a) Whitening toothpaste
b) Gum health toothpaste
c) Sensitivity toothpaste
d) Cavity protection/multi-benefit toothpaste
Do you have bad breath?
*
Yes
No
How often do you drink tea?
*
Every day
A few times a week
Once a week
Rarely
Never
How often do you drink coffee?
*
Every day
A few times a week
Once a week
Rarely
Never
What is your primary reason for seeking our product/service? Optional
To address a specific problem or pain point
For general self-improvement or confidence boost
Recommended by a friend, family member
Recommended by your dentist
Preparing for a special event or occasion
What is most important to you when choosing a teeth whitening provider? Optional
Reputation and patient reviews
Eco-friendly and cruelty-free products
Spa-like atmosphere and amenities
Flexible scheduling and convenient location
Effectiveness of the treatment
Cost and value for money
What type of content would you find most valuable from us? Optional
Educational blog posts or articles
Video tutorials or demonstrations
Case studies or customer success stories
Product comparisons or reviews
Exclusive promotions or discounts
What is your biggest challenge when it comes to teeth whitening? Optional
Finding time for lengthy treatments
Sensitivity from whitening products
Choosing the right whitening option
Affordability of professional treatments
Email
*