What Best Describes Your Condition?
*
I Have All My Teeth
I'm Missing One Tooth
I'm Missing Multiple Teeth
I'm Missing All My Teeth
How Long Have You Been Missing Your Teeth?
*
I'm Not Missing Teeth
Less Than A Year
More Than A Year
Do You Currently Have Any Of The Following Treatments?
*
Crowns and/or Bridges
Partials
Dentures
None of the 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
Can't 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?
*
1 - Very Little, I'm Not In A Rush
2- Moderate, I-3 Months
3 - High, I'm Looking For Help Now!
Have You Had Treatment Plans From Other Doctors For Dental Implants Recently?
*
Yes
No
Are You The Decision Maker In Regards To Your Dental & Healthcare?
*
Yes
No
Are You Interested in Learning About Our Easy Monthly Payment Plans? If So, What Dollar Range Would You Like To Pay Monthly
*
No Financing
$50-149/Month
$150-$249/Month
$250-349/Month
Over $350/Month
Which Best Describes Your Current Credit Score?
*
Below 580
580-699
700+
I'm Not Sure
First Name
*
Last Name
*
Phone
*
Email
*
What Location Is Most Convenient For You?
*
1212 New York Ave NW, Ste. 430 Washington, DC 20005
15200 Shady Grove Rd #105A Rockville, MD 20850