Tell us more about your current dental condition: *

I am missing all my teeth

I am missing many teeth or have many teeth breaking down

I am missing only a few teeth and looking for single teeth replacements

I am not sure

Are you currently struggling with dental pain? *

Yes

I struggle with dental pain occasionally

Are there foods you enjoy that you are unable to eat due to your dental condition? *

Yes

No, I can function well with my current condition

Have you looked into dental implant options or had a dental implant consultation in the past? *

No, this is my first consultation

Yes, I have been evaluated for dental implants

Is there a treatment option you are most interested in learning more about? *

All on 4 (a non removable implant bridge that replaces all the teeth in an arch)

Snap In Dentures

Single tooth implants

I am not sure

Since dental insurance typically does not cover dental implants, many patients use financing for their treatment. Are you interested in learning more about dental financing options? *

Yes

No, I will not need financing options

Dental financing relies on credit score for approval. What range would you estimate your current credit score to be? This allows us to tailor the lenders we use towards your scenario. *

Below 550

550 - 650

650 - 700

700 +

Many of our dental financing companies allow co-signers or someone to carry the loan on behalf of the patient. Do you have a co-signer available? *

Yes

Maybe

Would you be interested in a complimentary consultation to meet with Dr. Alyssa Mencini and review personalized options? *

Yes

No, not at this time

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

Our Practice Is Located In Mesa, AZ. Are You Willing To Travel To This Location? *

Yes

Is There Anything Else You Would Like Us to Know About Your Dental Needs or Concerns? *

First Name *

Last Name *

Postal Code *

Phone *

Email *