Our Clinic Specializes in Dental Implants. Choose what describes you best:
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I need Dental Implant to replace ONE missing tooth
I need Dental Implants to replace Multiple missing teeth
I need extractions and replacing the extracted teeth with Dental Implants
I don't need Dental Implants
New patients are seen at 639 Hempstead Turnpike, Franklin Square, NY 11010. Can you commute to this location
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YES
NO
Have You Ever Had Dentures?
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Yes, Upper Denture Only
Yes, Lower Denture Only
Yes, Both Upper and Lower Dentures
I never had Dentures
If You Ever Had Dentures, what best describes your situation?
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You experience one of the following with your denture: It rocks and moves around, it's hard to talk, it's too bulky, it hurts you when you wear it, you cannot taste food very well, you have too much saliva when you wear it, it makes your lips puff out, your tongue has no space, you don't like to use denture glue,
I am happy with my dentures
I never had dentures
DOES YOUR CONDITION HAVE A NEGATIVE IMPACT SELF ESTEEM AND CONFIDENCE?
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YES
NO
Did Your Condition Affect your Ability to Eat the Food You Like?
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Yes
No
WHAT IS THE MOST IMPORTANT OUTCOME YOU ARE LOOKING FOR?
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BEST ESTHETIC RESULT
BEST FUNCTION AND LOW MAINTENANCE
BOTH ESTHETICS, FUNCTION AND LOW MAINTENANCE
THE LEAST EXPENSIVE IMPLANT SOLUTION
WHAT IS THE MOST IMPORTANT FACTOR THAT PREVENTED YOU FROM GETTING TREATMENT?
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TIME
MONEY
FEAR
CAN'T FIND THE RIGHT SPECIALIST
How Long Have You Been Missing Your Teeth? ( the longer teeth are missing the more the jaw bone shrinks)
I Still Have Most of My Teeth
1-6 Months
7-12 Months
1+ Year
Have You Had A Dental Implant Consultation With Another Dentist?
YES
NO
How Ready Do You Fee To Do Something About Your Situation?
Somewhat Ready
Very Ready
I Need Something FAST!
Do You prefer to pay the cost of your treatment in full and take advantage of this offer or get a monthly payment plan?
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I PREFER TO PAY IN FULL AND GET THE DISCOUNT
I PREFER A LOW MONTHLY PAYMENT
Which Best Describes Your Current Credit Score?
Below 580
580-699
700+
I'm Not Sure
First Name
Last Name
Phone
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Email
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