Which statement best describes your current dental situation? *

I’m missing most or all of my teeth

I’ve lost several teeth over time

I’m missing a few teeth

I still have nearly all my natural teeth

Are you currently experiencing significant dental problems?

All or most teeth are decayed

Constant pain or infection

Unable to tolerate denture or partial denture

How much does your current dental condition affect your daily life? *

Trouble eating

Ongoing pain

Low confidence

How soon are you hoping to improve your health, diet, and smile? *

3-6 months

1-3 months

Immediately

Have you spoken with a dental professional about implants before? *

Yes, I’ve had a consultation

No, not yet

Dental implant treatment is usually not covered by insurance, but payment options may be available. Which best applies to you? *

Yes, I would like to explore financing options

No, I would like to pay on my own

Financing approval is based on credit. Which range best describes your situation? *

Below 620

620-659

660-719

720+

Which range best reflects your approximate yearly income? *

Below $60,000

$61,000–$70,000

Above $70,000

Do you currently rent or own your home?

Rent

Own

What’s your first name? *

And your last name? *

Where can we email you? *

Best number to reach you *

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