Let's Start With You.

Everyone who comes to us has a different story.

Some people are hurting. Some can't eat the foods they love. Some are tired of hiding their smile. And some have spent years trying to save teeth that just keep failing.

Before we talk about dental implants, we'd like to understand what's happening to you—and what you'd like to change.

It only takes a couple of minutes.

At the end, you'll meet Amber, our Patient Advocate. She'll personally review what you share and reach out to help you understand your options.

What brought you here today? Choose the answer that best describes what's bothering you most. *

I'm dealing with pain or ongoing dental problems

I'm missing one or more teeth

My teeth make it difficult to eat or chew

I'm unhappy or embarrassed by my smile

My teeth keep breaking down and I'm tired of fixing them

I wear dentures and want something better

Something else

Which best describes your teeth right now? *

How are your teeth affecting your life right now? Choose all that apply. *

I have pain or discomfort

I can't eat some of the foods I want

I'm embarrassed or uncomfortable with my smile

I avoid smiling or being in photos

I worry about my teeth getting worse

I'm frustrated with dentures or removable teeth

I've spent a lot of time and money trying to keep my teeth

My teeth affect my confidence around other people

Other

If we could help you change one thing, what would matter most to you? *

Eating comfortably again

Getting out of pain

Smiling without thinking about my teeth

Feeling more confident around other people

Having teeth that feel secure and dependable

Finally putting my dental problems behind me

Honestly, all of the above

There's one thing we'd really like to know.

What would having a healthy, confident smile allow you to do-or feel-that you can't today?

There is no right answer. Tell us whatever you'd like us to know.

A healthy, confident smile would allow me to..... *

Amber will personally read what you share before she contacts you.

Have you talked with another dentist about replacing your teeth? *

No, this is my first step

Yes, but I wasn't comfortable moving forward

Yes, but I still have questions

Yes, and I'm comparing my options

I've actually been told I'm not a candidate

If you found a solution that felt right for you, when would you hope to get started? *

As soon as possible

Within the next 1–3 months

Within the next 3–6 months

I'm still researching and don't have a timeline yet

Thank You for Sharing That With Us.

What you've told us helps us understand much more than what's happening with your teeth.

It helps us understand what you're hoping to get back.

If Esteem may be a good fit for you, we'll help you understand your treatment possibilities, timing and costs.

And because full-mouth treatment is a significant investment, we'll also ask a few questions about financing so Amber can be better prepared to discuss the options available to you.

Would information about payment or financing options be helpful to you? *

Yes

Maybe—I would like to understand what's available

No, I don't expect to need financing

To help us understand which financing options may be available, which range best represents your approximate credit score? *

Some financing options allow a co-applicant. If that became helpful, is there someone you might be comfortable applying with? *

Yes

Possibly

I'd rather discuss this with Amber

Radio Our practice is in McKinney, Texas. Would you be able to come to McKinney for your consultation and treatment? *

Yes

Yes, if I feel Esteem is the right fit for me

I'm not sure yet

NOW: MEET AMBER

She's the person on the other side of the this form.

Hi, I'm Amber, the Patient Advocate for Esteem.

When you submit your information, I'm the person who will receive it.

I'll read what you've shared before I contact you so you won't have to start your story all over again.

I'll reach out by phone or text to introduce myself, answer your initial questions and learn a little more about what you're hoping to change.

There's no pressure to make a treatment decision.

My job is to simply help you understand what's possible and decide whether taking the next step with us feels right for you.

When you see my call or text, please answer. I'm looking forward to talking with you.

meet amber

Amber

Esteem Patient Advocate

How Should Amber Reach You?

First Name *

Last Name *

Phone *

Email *

What's the best way for Amber to contact you first? *

Text me

Call me

Either is fine

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