Which Condition Best Describes You?
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Missing 1 Tooth
Missing Multiple Teeth
Struggling With Traditional Dentures
Most Of My Teeth Are In Pretty Bad Shape
How Long Have You Been Missing Your Teeth? (The longer teeth are missing the more the jaw bone shrinks)
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I Still Have Them
1-6 Months
7-12 Months
1+ Years
6+ Years
Are You Currently Unable To Eat Certain Foods Or Have To Modify The Way You Chew?
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Yes
No
Are You Currently Trying To Find Relief From Any Kind Of Pain Or Discomfort?
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Yes
No
Are You Currently Experiencing A Lack Of Confidence In Social Situations or Find Yourself Hiding Your Smile?
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Yes
No
Dental Implant procedures are not covered by insurance. However, many affordable payment plan options exist. Are you interested in a payment plan option?
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Yes. I'm interested in affordable payment plan options
No. I will not need a payment plan
Payment plans are available based on credit approval of the patient or a co-signer. Which best describes your credit?
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(Very Poor) Under 500
(Poor) 501-600
(Good) 601-700
(Very Good) 650-699
(Excellent) 700+
I Don't Know
Based on your credit score you may not qualify for financing without a co-signer. Do you have someone with good credit history who would co-sign with you?
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Yes
No
How Ready Do You Feel To Do Something About Your Situation?
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Somewhat Ready
Very Ready
I Need Something FAST!
What Is Your Name?
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What Is Your Best Email Address?
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What Is Your Best Phone Number?
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