Dr. Edwin Lewandowski

Smile and look carefully at your teeth, then answer the following questions. Once finished, please click 'Submit'. We will contact you to discuss the questionnaire in person.

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*	First Name:
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1.	Do you have concerns about your smile? Yes No
	Please explain:
2.	Do you have any general questions for your dentist ? Yes No
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3.	Would you like us to contact you ? Yes No
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