What best describes your current condition? *

I have all of my teeth

I'm missing one tooth

I'm missing multiple teeth

I'm missing all of my teeth

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Are you currently in any pain? *

Yes

Does your condition have a negative impact on your ability to eat or chew certain foods? *

Yes

How long have you been missing teeth? *

I still have them

1-6 Months

7-12 Months

1+ Years

When was the last time you were seen by a dentist? *

Within a year

More than 2 years

More than 5 years

10+ years

Have you had a dental implant consultation with another dentist? *

Yes

How ready do you feel to do something about your situation? *

High, I'm ready to take action now.

Moderate, In the next 1-3 months.

I'm just exploring right now.

Are you currently experiencing a lack of confidence in social situations or find yourself hiding your smile? *

Yes

What is your desired outcome? *

Restore my smile

Improve my chewing function

Both

Other

Dental Implant procedures are not covered by insurance. However, many affordable payment plans are available. Are you interested in a payment plan option? *

Yes. I'm interested in affordable payment plan options.

No. I am aware of the potential cost for implants and will not need financing options.

Which of the options below most accurately represents your current credit score? *

(Excellent) 750+

(Great) 700-749

(Good) 650-699

(Fair) 600-649

(Cosigner needed) Under 599

Do you own your own home? *

Yes

Which best describes your current household monthly income? *

Over $8,000

$3,000 to $8,000

Under $3,000

Which location is closest to you?

Arizona

Utah

Colorado

Open to traveling

First Name *

Last Name *

Enter your best email *

Phone *

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