Dental Implant Candidate Quiz

What is your biggest dental challenge? (Select all that apply)(Required)

I am missing a single tooth

I am missing multiple teeth

I am struggling with my traditional dentures

Most of my teeth are broken, decayed or missing

How long have you been struggling with this?(Required)

What has kept you from fixing your smile? (Select all that apply)(Required)

Nothing! I am ready right now.

Cost of dental procedures

Fear of dental procedures

Time involved in dental procedures

Have not found a dentist that I am comfortable with yet

If it was affordable, how soon would you be ready to move forward with treatment?(Required)

How do you plan to pay for your dental implant treatment? (Select all that apply)(Required)

Cash

Credit Card

Dental Insurance (please note: Medicaid not accepted)

3rd Party Healthcare Financing (CareCredit, LendingClub)

What is your current credit score range?(Required)

Select the option that best describes your situation.(Required)

Have you spoken to another dentist about treatment?(Required)

What was the price range of the other dentist’s treatment plan?(Required)

What is most important to you about your implant dentist? (select all that apply)(Required)

Lowest cost

Experience placing implants

Delivers highest quality

Financing options

Gentle and Caring

How did you hear about us?(Required)

Google Search

Facebook - Instagram

Internet Ad

Other

Name(Required)

First Last

Email(Required)

Phone(Required)