How many missing or broken teeth do you have? All 6+ 4-5 3 or less What is your age? 60 50-59 40-49 <40 Do you currently have any of these dental solutions? Denture or Partial Denture Bridge, Crown Dental Implant None of the above How long have you been missing your teeth? I still have them 1-6 months 7-12 years 1+ years Are you currently unable to eat certain foods or have to change the way you chew? Yes No Are you currently experiencing any pain or discomfort? Yes No Do you feel the need to hide your smile or experience a lack of confidence in social situations due to your teeth? Yes No Have you previously had a dental implant consultation with another dentist? Yes No How ready are you to do something about your situation? Somewhat ready Very Ready I need something NOW! Dental implant procedures aren't covered by insurance. However, affordable payment plans are available. Are you interested in a payment plan? Yes. I'm interested in affordable plan options. No. I've been saving for this procedure and will not need a payment plan. Payment plans are available based on credit approval of the patient or a co-signer. Which of these best describes your credit? (Very Poor) Under 500 (Poor) 500-649 (Good) 650-749 (Excellent) 750+ First Name Last Name Email Phone Location Choose Location Van Nuys West Covina Time's up