Does your smile need a makeover?

Your smile is one of the first things people notice about you and can not only affect how you look, but how you feel. 417 Magazine and Dr. Grant Olson of Innovative Dental are giving one lucky winner a smile you can be proud to show off and help better your personal life or career.

Here's how it works:

July 24 – August 30: Enter to win by filling out the form below. Tell us why you or someone you know deserves to be chosen and how your smile has negatively impacted your personal life or career.
September 9: 417 Magazine contacts 10 finalists for a consultation on September 14
September 14: Dr. Olson hosts consultations with the finalists and a winner will be chosen based on these visits
September 16: A winner is contacted and receives a customized smile, with major milestones and improvements documented in Dr. Olson's blog on 417mag.com.

We want you to love your smile, enter now! And read about the Better Your Smile winner of 2012 here!
 

Sponsored by:

 

First Name: Last Name:

Address: 

City, State: Zip:

E-mail Address:

Cell Phone:

Age: Sex: Male  Female

Profession/Employer:

Help us understand how your smile may influence your career:

If you are selected as a finalist, we would need to contact your dentist to obtain copies of your dental records.

Who is your dentist? When was your last appointment?

What was done?

Have you been advised to pull your teeth?

Are you missing any teeth other than your wisdom teeth?

Explain how your smile has negatively impacted you socially or in your occupation:

What are you most interested in accomplishing?

What has prevented you from receiving treatment in the past?

Please list any medical condition you have been treated for in the past, or are currently being treated for:

 

YES, I agree to the following terms and conditions outlined above

A PHOTO ATTACHMENT IS REQUIRED FOR YOUR SUBMISSION TO BE CONSIDERED

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