Which Condition best describes you?

I have one tooth missing

I have multiple tooth missing

I`m missing most of my teeth or all 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

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

Yes

Are You Currently Trying To Find Relief From Any Kind Of Pain Or Discomfort? *

Yes

Are You Currently Experiencing A Lack Of Confidence In Social Situations or Find Yourself Hiding Your Smile? *

Yes

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

Yes

Do you participate in any of these plans?

Insurance - PPO

Insurance - Non-PPO

MediCare

MediCal

None/Not Sure

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 phone number *

What Is Your Best Email Address? *

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