What Best Describes Your Condition?
I Have All My Teeth
I'm Missing One Tooth
I'm Missing Multiple Teeth
I'm Missing All My Teeth
How Long Have You Been Missing Your Teeth?
I'm Not Missing Teeth
Less Than A Year
More Than A Year
Are you currently wearing dentures?
What made you reach out to our office?
Insecurities about the way you look
All of the above
Select all that apply - Do you feel that tooth lose has affected your:
Enjoyment of Food
Does Your Condition Have A Negative Impact On Your Ability To Eat or Chew Certain Foods?
What Is The Most Important Outcome You Are Seeking?
Function - Eating, Chewing, Talking
Aesthetics - Beautiful, Natural Looking Teeth
Both Are Equally As Important
What Is The Most Important Factor That Has Prevented You From Getting Treatment?
Can't Find The Right Dentist
Please Describe your current Oral Health situation and the challenges that you are Experiencing.
What is your timeline to receive treatment?
Very little, I'm in no rush
Moderate, Within 1-3 months
High, I need help now
Have you seen another dentist about your condition?
No, This is my first consultation
Yes, I did not feel comfortable with the other practice
Yes, I'm looking to compare pricing
If this is a second opinion what type of implant solution are you looking for?
Fixed Full Arch
Implant Supported Denture
Are You The Decision Maker In Regards To Your Dental & Healthcare?
Most Dental Implant procedures are not covered by insurance. However we offer many payment plans that make it quite affordable and offer low monthly rates. Are you interested in a payment plan?
Yes I am!
No I will not need a payment plan
Are You Interested in Learning About Our Easy Monthly Payment Plans? If So, What Dollar Range Would You Like To Pay Monthly
How Familiar are you with the "All-On-4" treatment? Scale of 1-10
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
What Location Is Most Convenient For You?
New York, NY