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Are You Affected by Any of the Following Conditions?
Missing a single tooth
Missing multiple teeth
Poor-fitting traditional dentures
Most teeth in bad shape
Do You Currently Have Any of These Restorations?
Partial or full dentures
Crown and/or bridge
Dental implants
None of the above
How Long Have You Had Missing Teeth?
I’m not missing teeth
Less than a year
1 to 3 years
3 to 6 years
Over 6 years
Over 10 years
Do You Currently Watch What You Eat Because of Your Teeth?
Yes
No
Do You Currently Need Relief from Pain or Discomfort?
Yes
No
Do You Find Yourself Hiding Your Smile In Public?
Yes
No
Is There Anything Keeping You from Restoring Your Smile?
No! I’m ready to fix my smile today
Cost of treatment
Fear of the dentist
Time commitment
Are You Interested in a Cost-Effective Payment Plan For Financing Dental Implants?
Yes, I could afford up to $200 per month.
Yes, I could afford up to $400 per month.
Yes, I could afford up to $600 per month.
I do not need a payment plan.
Are You Ready to Improve Your Smile and Your Life?
I'm ready to start today.
I'm ready to start in the next 30 days.
I'm ready to start in the next year.
I'm not sure.
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Missing a single tooth
Missing multiple teeth
Missing a single tooth
Missing multiple teeth