What is your main reason for considering dental implants? *

When was your last dental visit? *

Within the last week

Within the last month

Around a year ago

It's been too long -- I can't remember

How many teeth are you currently missing? *

1 to 3

4 to 6

More than 6

I have all my teeth, but they're in poor condition (e.g. decay, gum disease, cracks)

A full arch dental implant treatment (All-on-X) typically ranges from $30,000 - $35,000 per arch, while a single implant costs between $5,000 - $7,500. How would you consider funding your treatment? *

Pay in full (cash, EFTPOS, credit/debit card)

Health insurance

Payment plan/financing (e.g., weekly or monthly payments)

Not sure/need more information

If you're a suitable candidate, when would you ideally like to begin treatment? *

As soon as possible

Within the next 1-3 months

Within the next 3-6 months

Possibly next year

Are you willing to attend a consultation and commit to follow-up appointments if you are a candidate? *

Yes

Maybe

Final Step: Tell Us About Yourself

Thank you for sharing your information! To match you with the right dental implant treatment, please provide your contact details below:

First Name *

Last Name *

Email *

Phone *

Preferred Clinic *