Dental Implant Smile Assessment
Which Condition Best Describes You?
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Missing One Tooth
Missing Multiple Teeth
Struggling With Traditional Dentures
Most Of My Teeth Are In Bad Shape
Do You Currently Have Any Of These Dental Solutions?
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Denture Or Partial Denture
Dental Implants
Bridge Crown
None Of The Above
How Long Have You Been Missing Your Teeth? (The Longer Teeth Are Missing, The More The Jawbone Shrinks.)
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I Still Have Them
1-3 Months
3-6 Months
6 Months to 1 Year
1 year +
Payment plans are available based on credit approval of the patient or a co-signer. Which best describes your credit?
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Excellent (720+)
Good (680-720)
Fair (620-680)
Below Fair (600-620)
Poor (Below 599)
First Name
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Last Name
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Email
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Phone
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When is the best time to contact you?
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Morning (9-12 Am)
Afternoon (12-5 PM)
Evening (5-8 PM)
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