Multiple Missing Teeth Consultation

Let's get you one step closer to your smile. Please answer the following questions

What will your new smile impact the most in your life?

Health

Wealth

Relationships

Confidence

All of the Above

Question, "What will your new smile impact the most in your life?" is required.

Are You Currently Unable To Eat Certain Foods Or Have To Modify The Way You Chew?

Yes

Question, "Are You Currently Unable To Eat Certain Foods Or Have To Modify The Way You Chew?" is required.

What is your TOP priority for your new teeth?

Strength & longevity

Esthetics

Price

Question, "What is your TOP priority for your new teeth?" is required.

Are you interested in affordable financing options?

Yes, I'm Interested

No, I don't need financing

Question, "Are you interested in affordable financing options?" is required.

Payment plans are available based on credit approval of the patient or a co-signer. Which best describes your credit?

Under 500

501-600

601-649

650-699

700+

I don't know

Question, "Payment plans are available based on credit approval of the patient or a co-signer. Which best describes your credit?" is required.

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

Question, "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?" is required.

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

Question, "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?" is required.

What is your Monthly budget?

$150 - $250

$250 - $500

$500 - $750

$750 +

Question, "What is your Monthly budget?" is required.

What is your budget?

$5,000 - $10,000

$10,000 - $20,000

$20,000 - $30,000

$30,000 +

Question, "What is your budget?" is required.

What is your contact info?

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