Which best describes your dental condition?

Missing 1 Tooth

Missing Multiple Teeth

My Dentures Don’t Fit

Most Of My Teeth Are In Pretty Bad Shape

How long have you been missing teeth?

I still have all of my teeth

Less than 1 Year

1-5 Years

5+ Years

What dental treatments have you tried?

Crown or Bridge

Partial Denture or Denture

Dental Implant(s)

None of the above

Are you unable to eat certain foods or do you have to modify the way you chew?

Yes

Do you experience a lack of confidence in social settings or find yourself hiding your smile?

Yes

Which of the following has been the main cause for not getting your teeth fixed?

Cost of the dental procedure

Fear of the dental procedure

Time involved with the dental procedure

Nothing! I am ready now

Major dental implant treatment may require a substantial financial investment. Are you interested in payment plan options?

No. I will pay out of pocket

Yes. I am interested in payment plan options

Maybe. I have not given thought to this

Payment Plans Are Available Based On Credit Approval Of The Patient Or A Co-Signer. Which Best Describes Your Credit?

(Very Poor) Under 500

(Poor) 501-600

(Good) 600-700

(Excellent) 700+

Do You Have Someone With Good Credit History Who Could Co-Sign With You?

Yes

How ready do you feel to do something about your dental situation?

Very ready!

Somewhat ready

Not sure yet

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