How many natural teeth are you currently missing? *

I have all my teeth.

I am missing a single tooth.

I am missing multiple teeth.

I am missing all of my teeth (Full Arch).

How recently have you been seen by a dentist about your dental condition? *

Within the last 12 months.

More than 2 years ago.

More than 5 years ago.

10+ years ago (or never).

Which main goal are you hoping to achieve with a dental implant solution? *

I want to rebuild my smile appearance and confidence.

I want to restore my ability to eat/chew all types of food.

Both A and B (A complete transformation).

Something else (I have a different primary concern).

Dental implant procedures are a significant investment. How do you plan to cover the costs? *

I will require assistance and am interested in flexible payment/financing options.

I plan to pay outright and do not need a payment plan.

If interested in financing, which range best represents your estimated current credit score? *

750+ (Excellent)

650-749 (Good)

600-649 (Fair)

Under 599 (Poor)

Do you currently own your primary residence (house, condo, etc.)? *

Yes

No

What is your estimated total household monthly income? *

Over $8,000

$4,000 to $8,000

Under $4,000

First Name *

Last Name *

Email *

Phone *

NEXT