Are Implants Right For You? Take our Implant questionnaire! 1. What is your primary dental concern?* Pain Chipped or cracked tooth Missing a single tooth Missing multiple teeth Issues with dentures Multiple concerns 2. How long has this been an issue?* 1-4 weeks 1-3 months 3-6 months 6-12 months Over 1 year 3. What is the time frame you would like to receive dental treatment if it is within your budget?* I'm just researching Immediately Within the next 4 weeks Within the next 3 months Within the next 12 months 4. Do you have Dental Insurance?* Yes No 4b. If you do not have dental insurance, are you in need of financing?* Yes No 5. Have you had a previous consultation with a dentist regarding dental implants?* Yes, I’d like a second opinion No, this will be my first consultation 6. Click and drag options to rank your concerns about finding an implant dentist.Seeing a dentist close to homeMost affordable optionMonthly payment arrangements availableQuality dental careGetting the best patient experience availableThe dentists' experience in implant dentistryA highly rated practice7. When is the best time of day to contact you Monday thru Friday?* 8 am-10 am 10 am-12 noon 12 noon-2 pm 2 pm-4 pm Name* First Last Cell Phone*Email* Zip Code* ZIP Code