What Best Describes Your Condition? *

I Have All My Teeth

Missing One Tooth

Missing Multiple Teeth

Missing All My Teeth

Do You Currently Have Any Of The Following Treatments? *

Crowns and/or Bridges

Partials

Dentures

None of Above

Have You Experienced Any Type Of Insecurities Regarding The Way Your Teeth Look? *

Yes

No

Does Your Condition Have A Negative Impact On Your Ability To Eat or Chew Certain Foods? *

Yes

No

What Is The Most Important Outcome You Are Seeking? *

Function - Eating, Chewing, Talking

Aesthetics - Beautiful, Natural Looking Teeth

Both Are Equally As Important

What Is The Most Important Factor That Has Prevented You From Getting Treatment? *

Time

Money

Fear

Cannot Find The Right Dentist

What Is your Level of Urgency To Find Relief From Any Type Of Pain Or Discomfort That You May Be Feeling? *

Very Little, Not In A Rush

Moderate, 1-3 Months

High, Looking For Help Now!

Have You Had Treatment Plans From Other Doctors For Dental Implants Recently? *

Yes

No

Which of our locations is most convenient? *

Charleston

Greenville

First Name *

Last Name *

Phone *

Email *

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