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Eligibilty Quiz
How Many Teeth Are You Currently Missing? *
All of Them
5+
3-5
1-2
What is your Age Range
70+
60-69
50-59
40-49
Under 40
What best describes your current Dental situation?
Denture or Partial Denture
Bridges, Crowns
1 Or More Dental Implants
More than 1 of the Above
None Of the Above
When did you first notice missing teeth? * Your timeline matters - the longer teeth are missing, the more your jaw bone naturally changes.
Not Missing Any Teeth
Less Than 6 Months Ago
1-3 Years Ago
Over 3 years ago
Are you currently having issues eating certain foods, or unable to eat certain foods, having to modify the way you eat etc.
Yes
No
Are you currently trying to find a solution for this discomfort, or is this impeding your current lifestyle?
Yes
No
Are you suffering regular pain, any Tooth infections currently or do you have toothaches regularly
Yes
No
Is your current situation affecting your lifestyle or social life, lack of confidence, hiding your smile etc.
Yes
No
Have you sought out help from other dentists, or have you had an appointment or consultation with another Implant specialist
Yes
No
How would you gauge your motivation to move forward with a solution such as implants ?
Still Investigating
I am Ready
Urgent - I am VEY READY
YESTERDAY - DIRE SITUATION
While dental implants are not covered by insurance, we offer affordable payment plans to help with your treatment. Would you like information about payment options?
YES, Please Share Payment Options
No, I have the means to pay on my own
Not Sure, Let's Discuss
What would you estimate to be your monthly budget for your new Smile treatment? 231ig
No Financing
$50-$149/Month
$150-$249/Month
$250-$349/Month
Over $350/Month
To help find your best financing option, could you share your general credit range? * (All information is confidential and helps us match you with available payment plans)
Excellent Credit - 700+
Good Credit - 640-699
Fair Credit - 580-639
Rebuilding Currently below 580
I have a Co-Signer
Not Sure, maybe we can Discuss Options
What Is your Zip Code
First Name
Last Name
Email
*
Phone
*
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