
				February 6, 2012

You Are Invited . . ., Georgia Dentist, Cosmetic Dentist

We'd like to get to know you and will be happy to send you information or arrange an appointment. Please respond to the areas below:

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Please send more information on (address listed below) ...
Appointment Hours
General Dentistry
Dental Restorations/ Tooth Replacement
Cosmetic Dentistry
Gum Therapy
Other

Please call me at to arrange a consultation appointment to discuss ...
Crowns or Crown & Bridge options
Cosmetic Dentistry
Dental Implants
Gum Therapy
Regular Care Dentistry
An immediate need

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Address

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I have a current dentist whom I see on a regular basis	Yes	No
I am missing one or more natural teeth	Yes	No
I wear a denture or partial	Yes	No
I would like to improve the appearance of my smile	Yes	No
I am fearful of dental visits and experience anxiety during them	Yes	No
I have all of my natural teeth and would like to keep them all my life	Yes	No

I would like to discuss/arrange a group presentation on dentistry.

Yes

I am years old and am

Male

Female

Thank you for visiting our web site!
We hope to meet you soon!

Richard W. Hedlund, DDS
1742 Mt. Vernon Road,
Suite 250 • Dunwoody, Georgia 30338
(770) 399-6799
info@wheregeorgiasmiles.com

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