General Form | Smile Solutions HI

Dr. Kim practices biologically focused, whole-body aware dentistry designed for long-term health and function.

Section 1

Full Name

Email

Phone

What describes you best?

New client, interested

Returning client

Other

Are you specifically looking for a biologically focused or holistic dental approach?

Yes, this is important to me

Im interested in learning more

Im open to either

Necessary

Section 2

When was your last dental visit?

Within 6 months

6-12 months

1-2 years

More than 2 years ago

Are you currently experiencing discomfort?

Yes - Urgent

Mild discomfort

No Pain

Section 3

Do you have any of the following health considerations? (Check ALL that apply)

Are you interested in? (Check ALL that apply)

Are you currently missing teeth, wearing implants or dentures?

Yes

No

Section 4:

How soon will you like to be seen?

As soon as possible

Within 2 weeks

Within 1 month

Flexible

Are you the primary decision maker for your care?

Yes

No

Dr. Kim’s practice focuses on personalized, high-quality care rather than volume-based dentistry.

Are you comfortable investing in comprehensive exams and customized treatment when recommended?

Choose what applies

Yes

I would like more information

I am unsure

Are you looking for the lowest cost dental option?

No, I value quality

I am looking at other options

Yes

808.949.4145

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but first we have some questions for you