Test Page

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 .