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Select All Current Dental Issues *

Missing Some Teeth

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Has Tooth Loss Affected Your *

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What is the most important outcome you are seeking? *

Function - Eating, Chewing, Talking

Aesthetics - Beautiful, Natural Looking Teeth

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Are You Willing to Travel to Our Practice in Wilmette, IL? *

Yes

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What Is Your Timeline To Receive Treatment? *

I'm Flexible, No Rush

Within 1-3 Months

I Need Help Now

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Have You Seen Another Dentist About Your Issues? *

No, This is My First Consulation

Yes, But I Did Not Feel Comfortable With The Other Practice

Yes I am Looking To Compare Options/Prices

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Do You Have a Household Income of $24,000+ (Can Be Your Income Plus a Partner or Spouse) + Have a Credit Score of 570 or Higher? *

Yes

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What Is The Most Important Factor That Has Prevented You From Getting Treatment?

Money

Time

Fear

Can't Find The Right Dentist

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What Type of Implant Solution Are You Looking For?

Fixed Full Arch

Implant Supported Denture

Single Implant

Traditional Denture

Not Sure

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