What Best Describes Your Condition? *

I Have All My Teeth

I'm Missing One Tooth

I'm Missing Multiple Teeth

I'm Missing All My Teeth

How Long Have You Been Missing Your Teeth? *

I'm Not Missing Teeth

Less Than A Year

More Than A Year

Do You Currently Have Any Of The Following Treatments?*

Crowns and/or Bridges

Partials

Dentures

None of the Above

Have You Experienced Any Type Of Insecurities Regarding The Way Your Teeth Look? *

Yes

Does Your Condition Have A Negative Impact On Your Ability To Eat or Chew Certain Foods? *

Yes

What Is The Most Important Outcome You Are Seeking? *

Function - Eating, Chewing, Talking

Aesthetics - Beautiful, Natural Looking Teeth

Both Are Equally As Important

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

Time

Money

Fear

Can't Find The Right Dentist

What Is your Level of Urgency To Find Relief From Any Type Of Pain Or Discomfort That You May Be Feeling? *

1 - Very Little, I'm Not In A Rush

2- Moderate, I-3 Months

3 - High, I'm Looking For Help Now!

Have You Had Treatment Plans From Other Doctors For Dental Implants Recently? *

Yes

Are You The Decision Maker In Regards To Your Dental & Healthcare? *

Yes

If You Are Looking For Monthly Payments What Payment Range Would You Feel Comfortable With? *

No Financing

$150-$249/Month

$250-349/Month

Over $350/Month

Dental Implant Procedures Are Not Covered By Insurance. However, We Offer Many Payment Plans That Make It Quite Affordable And Offer Low Monthly Rates. Are You Interested In A Payment Plan? *

Yes

Which Best Describes Your Current Credit Score? *

Below 580

580-699

700+

I'm Not Sure

First Name *

Last Name *

Phone *

Email *

What Location Is Most Convenient For You? *

7600 Fern Ave Building 600 Shreveport, LA 71105

1050 Bancorp South Circle Suite 400 Bossier City, LA 71111

940 Keyser Ave Natchitoches, LA 71457