What is your main reason for considering dental implants? *

Missing one or more teeth

Dentures are uncomfortable or loose

Difficulty chewing or eating

Cosmetic appereance

Are You Currently Wearing Dentures? *

Yes

If This Is A Second Opinion What Type Of Implant Solution Are You Looking For? *

Fixed Full Arch

Implant Supported Denture

Single Implant

Traditional Denture

Not Sure

Are you currently experiencing any of the following? (select all that apply)

Pain or discomfort when chewing

Jawbone loss or facial changes

Gum inflammation or bleeding

I have metal-based implants and want them evaluated

None of the above

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

Time

Money

Fear

Can't Find The Right Dentist

Are you familiar with biological dentistry or holistic dental care? *

Yes

I've heard of it but don't know much

What concerns do you have about dental implants? *

Cost/financing options

Surgery or healing time

Use of metals or foreign materials

Health risks or long-term effects

I’m not sure what questions to ask

How Fast Are You Looking To Change The Way You Smile? *

Very little, I'm in no rush

Moderate, Within 1-3 months

High, I need help now

Would you prefer a metal-free, biocompatible implant option? *

Absolutely – that’s very important to me

I’d like to learn more about it

I’m okay with traditional materials

Not sure

Are You Interested In Learning About Financing Options? *

Yes

Which option most closely represents your credit score? *

500 - 550

551 - 600

601 - 650

651 - 700

701+

For Your Convenience, We Will Send You The Customized Information In Regards To Pricing For Dental Implants Via Text And Email *

Yes send me the information

No, I do not wish to receive information regarding pricing for dental implants

By Selecting No, We Have No Immediate Way To Send You The Information That You Are Requesting. *

Yes I consent to receive this information

I would like to schedule an appointment to talk in person

I would like to speak to someone via phone call to discuss

I do not want this information

Our Practice Is Located In New York, NY. Are You Willing To Travel To This Location? *

Yes

Is There Anything Else You Would Like Us to Know About Your Dental Needs or Concerns? *

First Name *

Last Name *

Postal Code *

Phone *

Email *