Which Best Represents Your Dental Situation? *

I Have All My Teeth

I'm Missing One Tooth

I'm Missing Multiple Teeth

I'm Missing All My Teeth

0% - Completed

How Long Have You Been Missing Your Teeth? *

Less Than A Year

More Than A Year

9% - Completed

Do You Currently Have Any Of The Following Treatments? *

Crowns and/or Bridges

Partials Dentures

Full Dentures

None of the Above

18% - Completed

Does Your Dental Condition Affect Your Ability To Eat or Chew Certain Foods? *

Yes

No

27% - Completed

What Outcome Is Most Important To You? *

Functionality - Eating, Chewing, Speaking

Appearance - Attractive, Natural-Looking Teeth

Both Are Equally Important

36% - Completed

What Has Been The Biggest Barrier To Getting Treatment? *

Time

Cost

Fear

Not Finding the Right Dentist

45% - Completed

How Urgent Is Your Need For Dental Care? *

Low, I'm Not In A Hurry

Moderate, Within 1-3 Months

High, I Need Help Immediately!

55% - Completed

Have You Recently Received Dental Implant Treatment Plans From Other Dentists? *

Yes

No

64% - Completed

Are You The Primary Decision Maker For Your Dental and Healthcare Needs? *

Yes

No

73% - Completed

Are You Interested in Learning About Our Financing Options? If So, What Monthly Payment Range Suits You? *

No Financing Needed

$50-$149/Month

$150-$249/Month

$250-$349/Month

Over $350/Month

82% - Completed

How Would You Describe Your Current Credit Score? *

Below 580

580-699

700 and Above

I'm Not Sure

91% - Completed

First Name *

Last Name *

Phone *

Email *

Preferred Language for Communication

English

• English
• Spanish
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