Which service will help you with your smile journey?

*

Periodontics

Sleep Apnea & Airway Treatment

Cosmetic Dentistry

Implant Dentistry

Sedation Dentistry

Do you suffer from any of these issues? *

Bleeding Gums

Loose Teeth

Pain When Chewing

Tooth Sensitivity

Have you ever had periodontal consultation? *

Yes

No

Do you suffer from any of these? *

Snoring

Sleep Deprivation

Awaking with a Sore Throat

Choking and gasping while sleeping

Difficulty of falling asleep or staying asleep

Have you ever had a consultation for Sleep Apnea? *

Yes

No

What would you like to change about your smile? *

Shape

Color

Alignment

Functionality

Which condition best describes you? *

I have 1 tooth missing

I have multiple teeth missing

I'm missing all of my teeth or most of my teeth

I'm Struggling With Traditional Dentures

Do you currently have any of these dental solutions? *

Denture or Partial Denture

Bridge or Crown

Dental Implant

None of the above

How Ready Do You Feel To Do Something About Your Situation? *

Somewhat Ready

Very Ready

I Need Something FAST!

Do you get anxious going to the dentist? *

Extremely

Somewhat

Not Really

Not At All

Do you have highly sensitive teeth? *

Yes

No

Would you feel more comfortable getting dental work done with the assistance of sedation dentistry? *

Extremely

Somewhat

Not Really

Not At All

How long have you been suffering from your symptoms? *

0-6 Months

6-12 Months

1-2 Years

2+ Years

What is your name? *

What is your best email address? *

What is your best phone number? *