| 1. You've been seeing things a little difrntly latley? |
no |
|
yes |
| 2. you havent had any headaces recently? |
no |
|
yes |
| 3. In the hall way at skool u sometimes or usually accidentley bump into ppl |
no |
|
yes |
| 4. Your teeth are crooked, caved in, and not rite |
no |
|
yes |
| 5. Are your teeth rotted anywhere? |
no |
|
yes |
| 6. When you look upclose or far away things seem ok? |
no |
|
yes |
| 7. Have you been told you need braces? |
no |
|
yes |
| 8. Your smile is not flattering |
no |
|
yes |
| 9. u always get headaces and its not from noise or u dont normally get headaces |
no |
|
yes |
| 10. You've been told you dont need glasses or braces? |
no |
|
yes |
| 11. Do you want or need braces? |
no |
|
yes |
| 12. Sometimes you get headaces when u usually dont |
no |
|
yes |
| 13. Your teeth are almost or are straight? |
no |
|
yes |
| 14. Your teeth are crooked |
no |
|
yes |
| 15. things seem blury, unclear, cloudy, or they could b betr upclose or far away |
no |
|
yes |
| 16. You dont know or not if u need braces? |
no |
|
yes |
| 17. ur eyes hurt or sometimes it feels like u got something in em |
no |
|
yes |
| 18. Do you think you need glasses or do u want them? |
no |
|
yes |
| 19. You dont like your smile |
no |
|
yes |
| 20. your teeth are discolored |
no |
|
yes |
