What best describes your condition?
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I have all of my teeth.
I am missing one tooth.
I am missing a few teeth.
I am missing many teeth.
I am missing all of my teeth.
How long have you been living with tooth loss?
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0-2 Years
2-5 Years
5-10 Years
Over 10 Years
What is the most important outcome you are seeking?
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Function - eating, chewing, talking
Aesthetics - beautiful, natural-looking teeth
Both are equally as important
What is the most important factor that has prevented you form getting treatment?
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Time
Fear
Money
Can't find the right dentist
What is your level of urgency to find a solution for your dental needs?
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Very little, I'm not in a rush
Moderate, 1-3 months
High, I'm looking for help now!
Have you had a consultation or treatment plan from other dentists for dental implants?
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Yes
No
Do you have a valid US Social Security Number for any potential financing needed for your treatment?
Yes
No
Upon credit approval or with the help of a cosigner, payment plans are available. Which best describes your credit?
*
(Very Poor) Under 500
(Poor) 500-649
(Good) 650-749
(Excellent) 750+
I don't know
What is your preferred location?
*
Cherry Creek
Broomfield (Westminster)
Boulder
First Name
*
Last Name
*
Phone
*
Email
*