Ealing Implants Quiz

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1. What is the biggest problem that you’re having with your teeth right now:*

I am missing a single tooth

I am missing multiple teeth

I am struggling with traditional dentures

I need to have 1 or multiple teeth removed

Most of my teeth are decayed, broken, or missing

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3. What would be the biggest benefit if we could help you fix this problem?

My teeth wouldn’t hurt anymore

I could smile with confidence again

I could eat normally again

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2.What's Kept You From Fixing Your Smile?

Nothing! I'm ready right now!

Cost of dental procedures

Fear of dental procedures

Time involved indental procedures

Haven't found adentist I'm comfortable with yet

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4. If you could fit implants into your budget are you ready to start right away?

YESNO

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How Long Have You Been Struggling With This?

Less than a month

Less than 6 months

Less than 1 year

More than 1 year

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Are You Ready To Schedule Your Consultation?

YESNO

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Enter your name, email and phone number below so that we can send you your results.By submitting this form you give us permission to contact you via phone, email or text message. Your information is safe, secure and will only be used to contact you about your free dental implants consultation.

Full Name

Please enter your email

Please enter your phone