Step 1 of 16 6% 1. Have you ever had an implant consultation for full arch treatment before? Yes No 2. What is your current dental situation? I am missing teeth (1 to 3 teeth) Second Choice I am missing more than 3 teeth I have no teeth left I have all my teeth 3. Do you currently have any teeth that are loose or need to be extracted? Yes No 4. Do you currently wear or have any of the following restorations in your mouth? A removable partial denture or full denture Dental implants Crown and bridge work None of the above 5. Are you interested in treating your upper or lower arch? Upper Arch Lower Arch Both Arches 6. Are you currently experiencing any pain or discomfort? Yes No Sometimes 7. Are you having any trouble eating or chewing certain foods? Yes No 8. Do you feel like you are able to enjoy the variety of food you would like to eat? Yes No 9. Do you find yourself hiding your smile when talking or laughing? Yes No 10. Are you experiencing a lack of confidence due to your smile? Yes No 11. What is your age range? 40 to 50 years old 50 to 60 years old 60+ years or older Under 40 years old 12. What is your biggest motivator for seeking this type of treatment? I am tired of being in pain and not eating well I want to improve my confidence and smile again I want to invest in a long-term solution for my dental problems All of the above 13. Insurance does not typically cover full arch treatment. Are you financially prepared for this type of treatment? I would need to discuss the monthly payment options available I feel prepared for the expense I do not have good credit and do not think financing is an option 14. Do you have a general dentist you see regularly? Yes No 15. How ready are you to start treatment? Right away! In a few weeks In a few months I’m not sure What is your Phone number?(Required) What is your first and last name?(Required) What is your email?(Required) How do you prefer to be contacted(Required)Select OneEmailText Providing Specialty Surgical Services to Atlanta Since 1980 Call Now
