Find out if dental implants could be right for you!
How many teeth are you missing?
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A. None
B. One
C. Multiple
D. All
How long ago did you lose your teeth?
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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?
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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?
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Yes
No
Do you have difficulty chewing or eating some types of food?
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Yes
No
Which of these is most important to you?
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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?
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A. Finances
B. Busy Schedule
C. Concerns about the treatment
D. Not knowing where to start
Which of these treatments have you had done?
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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?
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Yes
No
Can you make final decisions about your health for yourself?
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Yes
No
Select the option that is closest to your credit score.
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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?
*
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