Are You Currently Unable To Eat Certain Foods Or Have To Modify The Way You Chew? *

Yes

Are You Currently Experiencing A Lack Of Confidence In Social Situations or Find Yourself Hiding Your Smile? *

Yes

What’s really kept you from getting help? *

What's your name? *

What’s the BEST email to add to your file? *

What’s the BEST phone number we can call to reach you? *

Dental implant treatments are not covered by insurance.

However, payment plans are available through dental financing & healthcare financing and are typically approved based on the credit history of the patient and/or a co-signer.

Which affordable payment options would you be interested in? *

Monthly payment plan through dental financing

My own credit card

Which option best describes your monthly budget for your desired treatment? *

Less Than $300 Per Month

Between $300-$399

Between $400-$499

$500 or more

Based on your credit score, it looks like you will need help to qualify for treatment through dental financing. Do you know someone with a good to excellent credit history who can help you apply for the financing? *

Yes, My Spouce

Yes, A Family Member

Is this a treatment you’d want to start soon? (Patients without teeth lose up to 25% of their bone width within the first year. The longer you wait to replace missing teeth, the more advanced your bone loss will become). *

I want this done ASAP. I’m in pain / tired of feeling sick and i’m ready to improve the quality of my life

I want this done 1-3 months from now. I definitely want this treatment

I just need a little more time.I’m still searching, I don’t know yet.

Upon receiving your survey, we will contact you to schedule your consultation. Do you commit to answering our call to schedule your consultation? *

Yes, I want to take the next step to improve my oral health

No, I cannot commit to answering the call to schedule my consultation

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.