How many teeth are you missing in total?

1-3 teeth

More than 3 teeth

Almost or all my teeth

I am not missing any

What is your age?

60+

50-59

40-49

<40

Do you currently have any of these dental solutions?

Denture or Partial Denture

Bridge, Crown

Dental Implant

None of the above

How Long Have You Been Missing Your Teeth? (The longer teeth are missing the more the jaw bone shrinks)

I Still Have Them

1-6 Months

7-12 Months

1+ Years

How do you intend to cover potential out-of-pocket costs for dental implant treatment, considering limited insurance coverage?

Savings or personal funds

Payment plan through the dental clinic

Credit card financing

Do you have a job or a source of income if you're considering financing your dental treatment through healthcare financing companies?

Yes, employed

Retired

Unemployed

Disabled

Interested in financing? Please select the option below that best describes your credit history.

Excellent (700 and above)

Good Credit (650-699)

Low Credit (below 650)

How would you like to be contacted?

Phone Call

Text me

I agree to receiving text messages and phone calls from the dental office in order to confirm an appointment time. I understand I can opt-out at any time by replying STOP. Message & data rates may apply.

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