FIND OUT IF I AM A CANDIDATE

How Many Teeth Are You Currently Missing? *

All

4-5

3 Or Less

What Is Your Age? *

60+

50-59

40-49

40 or less

Do you currently have any of these dental solutions? *

Denture or Partial Denture

Bridge, Crown

Dental Implant

None of the above

How Long Have You Been Missing Your Teeth? (The longer teeth are missing the more the jaw bone shrinks) *

I still have them

1-6 Months

7-12 Months

1+ Years

When was the last time you were seen by a dentist? *

Within a year

More than 2 years

More than 5 years

10+ years

Are You Currently Trying To Find Relief From Any Kind Of Pain Or Discomfort? *

Yes

Are You Currently Unable To Eat Certain Foods Or Have To Modify The Way You Chew? *

Yes

Are You Currently Experiencing A Lack Of Confidence In Social Situations or Find Yourself Hiding Your Smile? *

Yes

Do you own your own home? *

Yes

Have You Had A Dental Implant Consultation With Another Dentist? *

Yes

What is your desired outcome? *

Restore my smile

Improve my chewing function

Both

Other

How Ready Do You Feel To Do Something About Your Situation? *

Somewhat Ready

Very Ready

I Need Something Fast!

Dental Implant procedures are not covered by insurance. However, many affordable payment plans are available. Are you interested in a payment plan option? *

Yes. I'm interested in affordable payment plan options

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

Which of the options below most accurately represents your current credit score? *

(Excellent) 750+

(Good) 650-749

(Fair) 600-649

(Poor) Under 599

Which best described your current household monthly income? *

Over $8,000

$4,000-$8,000

Under $4,000

First Name

Last Name

Phone *

Email *

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