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What is the biggest problem that you’re having with your teeth right now:*
I'm missing few teeth, the remaining teeth are in good shape
I'm missing few teeth, the remaining teeth are in very bad shape
I want to get rid of my denture
I have no teeth and not wearing denture
Other
Have You ever had a dental Implant consultation before?
Yes
No
Why haven’t you fixed the problem yet?
I haven't found a dentist I trust
I haven't had time
The solutions I've found are too expensive
Other
What would be the biggest benefit if we could help you fix this problem?
I could smile with confidence again
I could eat normally again
My teeth wouldn't hurt anymore
What need to happen in order for you to move ahead to change your situation?
Nothing, I'm ready now
Understand more about the procedures and options
Find a dentist I can trust
Find an affordable payment option
If you could fit implants into your budget are you ready to start right away?
Yes
No
What would the budget you able put toward having your Teeth Healthy again?
$400 - $600 per month
More than $700 per month
Less than $350/month
Please confirm that your phone number can receive TEXT messages from us
We will not share your contact to anybody else
Yes
No
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