How many teeth are you currently missing? *

None

1-3 teeth

4-5 teeth

All of my teeth

Are you currently experiencing dental pain or discomfort? *

Yes

Do you currently wear dentures (full or partial)? *

No, I do not wear dentures.

Yes, I wear full or a partial denture.

Please describe your current oral health situation and any challenges you are experiencing. *

Insurance may cover only a small portion of denture or dental implant costs, with most expenses being out-of-pocket. Government assistance is not available. However, we offer third-party financing to make treatment more manageable.

Would you like to explore financing options? *

Yes, I’m interested in financing options.

No, I plan to pay in full.

I'm unsure; I would like to discuss this during a consultation.

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.*

Okay

Our practice is located in Belgrade, MT. Are you willing to travel to this location? *

Yes

By providing your phone number and email address, you agree to receive messages, notifications, reminders, and occasional marketing communication from Premier Choice Dental Center. You also agree to our terms of service and privacy policy. Message frequency varies. Message & data rates may apply. Text HELP to (406) 500-7440 for assistance. You can reply STOP or OUT to unsubscribe at any time.