How many missing or broken teeth do you have? All 6+ 4-5 3 or less None What is your age? 60 50-59 40-49 <40 None Do you currently have any of these dental solutions? Denture or Partial Denture Bridge, Crown Dental Implant None of the above None How long have you been missing your teeth? I still have them 1-6 months 7-12 years 1+ years None Are you currently unable to eat certain foods or have to change the way you chew? Yes No None Are you currently experiencing any pain or discomfort? Yes No None Do you feel the need to hide your smile or experience a lack of confidence in social situations due to your teeth? Yes No None Have you previously had a dental implant consultation with another dentist? Yes No None How ready are you to do something about your situation? Somewhat ready Very Ready I need something NOW! None 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. None 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+ None First Name Last Name Email Phone Location Choose Location Van Nuys West Covina Time's up