What Best Describes Your Condition *

I am Interested in Dental Implants

I am Interested in Fixed All-On-Four Permanent Teeth

I am Interested in Snap-On Dentures

I have other concerns

How Long Have Your Teeth Been Missing *

I Still Have Them

1-3 Months

3-6 Months

6 Months - 1 Year +

I Don't Have Teeth

What Would Be Your Biggest Life Change That We Could Help You Experience By Fixing Your Dental Problem? *

I could eat the foods I want to again!

I could smile with confidence and never be embarrassed in social situations.

My teeth or mouth would not hurt anymore!

What Has Kept You From Getting Implants Or Implant Dentures? *

Cost of Dental Work

No Free Time

Fear of Dental Work

Unfamiliar with my Options

I'm Ready Right Now!

Dental Implants Are Often Not Covered By Insurance. However, There Are Affordable Monthly Payment Plans Available. Are You Interested In A Payment Plan Option? *

Yes. I am Interested in affordable payment plan options.

No. I've been saving for this type of procedure and will not need a payment plan.

Payment Plans Are Available Based On Credit Approval Of The Patient Or Co-Signer. Which Best Reflects Your Credit Score? *

Under 600

600 - 649

650-800

No Credit Score

Based On Your Credit Score You May Not Qualify For Financing Without A Co-Signer. Do You Have Someone With Good Credit History Who Would Co-Sign With You? *

Yes

Unfortunately It Looks Like You Would Not Be Able To Qualify For Our Payment Plan Options. Do You Have Any Other Way To Pay For A Dental Implant Procedure? *

Savings

Retirement Account (401k, etc)

Other Loan (Home Equity, etc)

Help from a relative

No, I don't

Do You Feel Like You Are Ready To Do Something About Your Situation? *

I am interested, and may be ready

I am ready to do something, but want to explore my options

I want to start as soon as possible!

Contact Details *

Name *

Email *

Phone *

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