Which Condition Best Describes You?
Missing 1 Tooth
Missing Multiple Teeth
Struggling With Traditional Dentures
Most Of My Teeth Are In Pretty Bad Shape
Do you currently have any of these dental solutions?
Denture or Partial Denture
None of the above
(The longer teeth are missing the more the jaw bone shrinks)
How Long Have You Been Missing Your Teeth?
I Still Have Them
6 Months to 1 Year
1 Year +
Are You Currently Unable To Eat Certain Foods Or Have To Modify The Way You Chew?
Are You Currently Trying To Find Relief From Any Kind Of Pain Or Discomfort?
Are You Currently Experiencing A Lack Of Confidence In Social Situations or Find Yourself Hiding Your Smile?
What's Kept You From Getting Your Smile Fixed?
Nothing! I'm Ready Right Now
Cost Of Dental Procedures
Fear Of Dental Procedures
Time Involved With Dental Procedures
Haven't Found A Dentists I'm Comfortable With
Dental Implant procedures are not fully covered by insurance. However, many affordable payment plans exist. Are you interested in a payment plan option?
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?
(Very Poor) Under 500
I Don't Know
Based on your credit score you may not qualify for financing without a co-signer. Do you have someone who would co-sign with you?
How Ready Do You Feel To Do Something About Your Situation?
I Need Something FAST!
What Is Your Name?
What Is Your Best Email Address?
What Is Your Best Phone Number?
When is the best time to contact you?