Age

60+

50-59

40-49

Under 40

Do you have any of the following:

Denture/Partial

Bridge/Crown

Implant

None

How long have the teeth been missing for?

I still have them

1-6 months

7-12 months

1+ Years

Are you unable to eat certain foods / have you had to modify the way you chew?

Yes

No

Are you currently trying to find relief from any kind of pain or discomfort?

Yes

No

Are you currently experiencing a lack of confidence in social situations or find yourself hiding your smile?

Yes

No

Have you had a dental implant consultation with another dentist?

Yes

No

How ready do you feel to do something about your situation?

Somewhat Ready

Very Ready

I Need Something Now!

Implants may be minimally or not covered by insurance. However many affordable payment plans are available. Are you interested in a payment plan option?

Yes. I'm interested in affordable payment plan options

No. I've been saving for this type of procedure and will not need a payment plan

Payment plans are available based on credit approval of the patient or a cosigner. Which best describes your credit?

(Poor) under 660

(Fair) 660-699

(Good) 700-739

(Excellent) 740+

What Is Your Zip Code?

First Name

Last Name

Email *

Phone *

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