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Find out if you're a Candidate for Dental Implants
Answer the following questions to learn more about our pricing and financing options.
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1
What best describes your condition?
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I have all my teeth
I'm missing one tooth
I'm missing multiple teeth
I'm missing all my teeth
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2
How long have you been missing your teeth?
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I'm not missing teeth
Less than a year
More than a year
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3
Are you currently wearing dentures?
YES
NO
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4
What made you reach out to our office?
*
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Tooth pain
Missing teeth
Insecure about the appearance of my teeth
All of the above
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5
Does your condition have a negative impact on your ability to eat or chew certain foods?
*
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YES
NO
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6
What is the most important outcome you are seeking?
*
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Function - eating, chewing, talking
Esthetics - Beautiful Teeth
Both are equally important
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7
What has prevented you from getting treatment?
*
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Time
Money
Fear
Can't find the right dentist/office
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8
What is your timeline to receive treatment?
*
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Very little - I'm in no rush
Moderate - within 1-3 months
High - I need help now
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9
Have you seen another dentist about your condition?
*
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No, this is my first consultation
Yes, I did not feel comfortable with the other office
Yes, I'm looking to compare pricing
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10
What type of implant solution are you looking for?
*
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Fixed full arch
Snap-In denture
Single implant
Traditional denture
Not sure
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11
Are you the decision maker in regards to your healthcare?
*
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YES
NO
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12
Most dental implant procedures are not covered by insurance but we offer multiple financing solutions that make it quite affordable and offer low monthly rates. Are you interested in a payment plan?
*
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YES
NO
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13
Are you interested in learning about financing options? If so, what dollar range would you like to pay monthly?
*
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No financing needed
$200-400/month
$400-600/month
$600-800/month
Over $800/month
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14
How familiar are you with "All-on-4", "Teeth in a day" treatment? Scale 1-10
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15
We will send you personalized information in regards to pricing for dental implants via text and email.
*
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Yes, send me the information
No, I would prefer a call from an implant consultant
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16
What specific information would you like to give our implant consultant?
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17
Contact Information
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18
Our dental office is located in Puyallup, WA. Are you willing to travel to this location?
*
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YES
NO
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19
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