ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

How many teeth are you missing? *

Missing all of my teeth

Missing most upper teeth

Missing most lower teeth

Missing 1-3 teeth

Not missing teeth

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

Do you currently have any of these dental solutions? *

Bridges or crowns

Dentures or partial denture

Dental Implants

None of the above

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

What is your age? *

60+ years old

50-59 years old

40-49 years old

<40 years old

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

Have you seen another dentist about implants? *

Yes, at Center for Advanced Dentistry

Yes, at another dental office

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

When can you come to Center for Advanced Dentistry for your complimentary consultation? *

This week

Next week

Within the next 30 days

Not sure

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

Our starting price for a dental implant is approximately $19,999* per arch (jaw). Payments plans start at $274/mo. Would you like to see if you qualify for a payment plan? *

Yes, I would like to explore if I qualify for a payment plan

No. I’ve been saving for this type of procedure and will not need a payment plan

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

To help you find the best payment options, please select what range best describes your credit score *

Needs Improvement (Under 500)

Fair (500-649)

Good (650-749)

Excellent (750+)

I’m not interested in financing

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

What is your gender? *

Male

Female

Prefer not to say

ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

First Name *

Last Name *

Phone *

Email *

How did you hear about us?

Facebook
Instagram
Tiktok
Google
Doctor Referral
Radio
TV
Billboard
Print
Friend/family
Internet
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ARE YOU ELIGIBLE FOR SAME-DAY IMPLANTS?

Postal Code

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