ALL ABOUT YOU

    Please check next to the proper answer for each question below:

    I have difficulty cleaning my teeth: AlwaysSometimesNever
    I have difficulty eating and/ or drinking: AlwaysSometimesNever
    I have pain in my mouth or jaw: AlwaysSometimesNever
    I have difficulty talking: AlwaysSometimesNever
    I am hesitant to smile: AlwaysSometimesNever
    I cover my mouth when I talk, smile or laugh: AlwaysSometimesNever
    I am embarrassed about the way my teeth look: AlwaysSometimesNever
    People make fun of my teeth: AlwaysSometimesNever
    I worry people are looking at my teeth when I am talking: AlwaysSometimesNever
    I like to .
    I wish I could be .
    My Birthday is
    I am years old, and in the grade at school!
    I have a pet, it is a and its name is .
    My favorite thing about school is .
    My least favorite subject is .
    These friends of mine come here for their braces, too! .
    I have brothers and sisters.
    My favorite TV show is .
    My favorite food is .