Find out if dental implants could be right for you!

How many teeth are you missing? *

A. None

B. One

C. Multiple

D. All

How long ago did you lose your teeth? *

A. I’m not missing any teeth

B. Within the past year

C. Over a year ago

How urgently are you seeking relief from any discomfort? *

A. Very urgent: I need immediate relief!

B. Somewhat urgent: The sooner I can get treatment the better

C. Not urgent: No rush, I can wait

Have you ever felt insecure about your smile? *

Yes

Do you have difficulty chewing or eating some types of food? *

Yes

Which of these is most important to you? *

A. Function: Being able to eat and speak normally

B. Appearance: Having an attractive smile

C. Both are equally important

What’s your biggest barrier to seeking treatment? *

A. Finances

B. Busy Schedule

C. Concerns about the treatment

D. Not knowing where to start

Which of these treatments have you had done? *

A. Dentures

B. Crowns or bridges

C. Partial dentures

D. None of the above

Have you received a dental implant treatment plan from any other dentists recently? *

Yes

Can you make final decisions about your health for yourself? *

Yes

Select the option that is closest to your credit score. *

A. Over 700

B. 580-699

C. Under 580

D. I don’t know

Your Name *

Last Name *

Email Address *

What Is Your Best Phone Number? *

I Consent to Receive SMS Notifications

I Consent to Receive SMS Notifications, Alerts & Upcoming Details from My Dental and Implants. Message frequency may vary. Message & data rates may apply. Text HELP for assistance. You may reply STOP to unsubscribe at any time.

I Consent to Receive the Occasional Marketing Messages *

I Consent to Receive the Occasional Marketing Messages from My Dental and Implants. You can Reply STOP to unsubscribe at any time.