Hi there! Dr. Will here.

If you're reading this, you've likely heard about The Burkitt Center—our incredible dental office—and our cutting-edge Yomi robot, which places dental implants with unmatched precision.

I’d be honored to welcome you as one of our amazing patients! We’re proud to have people visit us not just from all over the U.S. but from around the globe.

To help us serve you best, please complete the questionnaire below. This helps our Patient Advocate, Taylor, understand your needs and ensure we’re the right fit for your dental care. By sharing a bit about yourself, you’re helping us create a personalized experience just for you.

I look forward to getting to know you better and hope to see you at The Burkitt Center soon.

Warm regards,
Dr. Will

First Name

Last Name

Email *

Phone *

Where did you hear about us?

Are you wearing dentures? If so, top denture or bottom denture?

No, I do not wear dentures.

Yes, I wear only a top denture.

Yes, I wear only a bottom denture.

Yes, I wear dentures on both upper and lower jaws.

Which situation is most similar to yours? If a tooth is extremely painful or should be pulled and hasn’t been yet, please include that as a “missing” tooth. Choose one:

How has your oral health affected your life? Select all that apply:

Do you know if you have gum disease and/or loose teeth? Choose the one that best describes you:

I do not have gum disease or loose teeth

I may have a little bit of gum disease and loose teeth

I definitely have some gum disease. My teeth are a little loose

I have very bad gum disease and very loose teeth

Why are you contacting Dr. Will and The Burkitt Center? Select all that apply:

What is the most important outcome you want from Dr. Will and The Burkitt Center?

Function - being able to chew and talk without pain or problems

Cosmetics - being comfortable to smile and loving how it looks

Both are important

Does your condition keep you from being able to chew certain foods well?

Yes

Why haven't you gotten this treatment done yet? Why have you waited?

Please describe your oral health condition and everything surrounding it as best you can. Feel free to tell us anything here... (Fears, insecurities, financial concerns, etc.)

Have you had a dental implant consult before, or have you seen another dentist about your condition?

No, this will be my first consult

Yes, but did not feel comfortable moving forward yet...

Yes, but I am looking for best price

How quickly are you wanting this to be taken care of?

I want to be seen for a new smile ASAP!

I don't mind waiting a few months

I am just shopping around and don't care to start anytime soon

Do you know what you are looking for with dental implants?

I am wanting just a denture that comes in and out of my mouth

I only need 1 or a few dental implants to replace teeth

I am wanting a brand new beautiful smile on implants that do not come in and out at all. (All-on-X, Fixed)

I am not sure

The Burkitt Center is located in Nolensville, TN, about 30 minutes south of Nashville. We offer cutting edge technology to help people live confident lives not plagued by dental pain. Are you willing to travel to this location to experience the most advance dental treatment in the nation? *

By providing my phone number, I agree to receive text messages from the business. Privacy Policy available at www.burkittcenter.com