Rogers - Dental Implant Assessment

Dental Implant Assessment
Which condition best describes you?

I have 1 - 3 missing teethI have 4 or more missing teethI have 1 or more teeth that needs to be extractedI'm struggling with traditional dentures
How long have you been missing these teeth?

1 - 6 months7 - 12 months1+ years6+ years
Have you been told by a dental professional that you have a tooth or teeth that need to be extracted?

YesNo
How long have you had traditional dentures?

Less than 1 year1 - 3 years3 - 6 years6+ years
Which of the following are you experiencing?

Unable to eat certain foodsHave to modify the way you chewPain or discomfortLack confidence in social situationsFind yourself hiding your smileAll of the above
Additional Information/comments:
Dental implants can be connected to teeth that are permanently attached or to teeth that are removable. Which type would you prefer?

Teeth that are removableTeeth that are permanent
We work with a number of financial lenders and many affordable payment plans exist. Are you interested in learning more about financing options?

Yes, I’m interested in learning about affordable payment plan optionsNo, I will not need a payment plan
Payment plan terms are available based on credit approval of the patient or a co-signer. Which best describes your credit?

700+ (Excellent)650-699 (Very Good)601-649 (Good)501-600 (Poor)Under 500 (Very Poor)I don’t know
Unfortuantely, individuals with a credit score below 500 may find it difficult to obtain affordable financing for dental implants. In some instances, the bank you have a relationship with for your personal finances may be an option. We recommend reaching out to your bank and asking if they have financing options that may work for you. If that is an option, please give us a call at (513) 231-1012.
How ready do you feel to do something about your dental situation?

I'm considering and just gathering informationSomewhat readyVery readyI need something FAST!
Would you like to talk with a dental implant expert from Rogers Family Dentistry to discuss your options and any questions you may have?

Yes, I have additional questions and would like to talk more.No, I'm all set for now.
Let's schedule a phone consultation to talk about your options! Please provide your name, a good email address and phone number to reach you at.
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