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, 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
6+ Years
Which of the following are you experiencing? (Check all that apply)
Unable To Eat Certain Foods
Have To Modify The Way You Chew
Pain Or Discomfort
A Lack Of Confidence In Social Situations
Find Yourself Hiding Your Smile
All of the Above
Dental Implant procedures are not covered by insurance. However, many affordable payment plan options exist. Are you interested in a payment plan option?
*
Yes. I'm interested in affordable payment plan options
No. I will not need a payment plan
Payment plans are available based on credit approval of the patient or a co-signer. Which best describes your credit?
*
(Very Poor) Under 500
(Poor) 501-600
(Good) 601-649
(Very Good) 650-699
(Excellent) 700+
I don't know
Based on your credit score you may not qualify for financing without a co-signer. Do you have someone with good credit history who would co-sign with you?
*
Yes
No
Unfortunately it looks like you would not be able to qualify for our payment plan options. Do you have any other way to pay for a Dental Implant procedure?
*
Savings
Credit Card
Retirement Account (401k, etc)
Other loan (Home Equity, etc)
Help from a relative
No, I don't
How Ready Do You Feel To Do Something About Your Situation?
*
Somewhat Ready
Very Ready
I Need Something FAST!
What Is Your Name?
*
What Is Your Best Email Address?
*
What Is Your Best Phone Number?
*