Which best describes your situation? *

I am missing 3 teeth or less

I am missing 4 to 6 teeth

I am missing more than 6 teeth

I am missing all my teeth

Which option below would be most ideal for you?

I want a completely new smile with dental implants

I want to redo the top teeth OR the bottom teeth with implants

I am interested in replacing one or a few teeth

I prefer to NOT replace any teeth

What Age Range Are You In?

60 & Up

50 to 59

40 to 49

Under 40

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

1-5 Years

6+ Years

Which of the following are you experiencing? (Check all that apply)

Unable To Eat Certain Foods

Have To Modify The Way You Chew

Pain Or Discomfort

A Lack Of Confidence In Social Situations

Find Yourself Hiding Your Smile

How Ready Are You To Do Something About Your Situation?

Somewhat Ready

Very Ready

I Need Something FAST!

Dental Implants are generally not covered by insurance. However, many affordable payment plan options exist. Are you interested in a payment plan option?

Yes. I'm interested in affordable payment plan options

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

Payment plan eligibility is based on the credit of the patient (or a co-signer). How would you describe your credit?

Under 620

620-699

700-749

750+

Dental implant procedures range from $17,000 to $60,000 on average, and monthly payment plans can start as low as $299/mo. Are you interested in utilizing a payment plan for your care?

Yes, I’d like to know if more about utilizing a payment plan

No, I don't need a payment plan

What is your ZIP code?

What is your name?

What is your best email address? *

What is Your Best Phone Number? *

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