Dentophobia - Lasting Smiles Dental Implant Center

What best describes your current condition?

I have all of my teeth
I'm missing one tooth
I'm missing multiple teeth
I'm missing all of my teeth

When was the last time you were seen by a dentist?

Within a year
More than 2 years
More than 5 years
10+ years

What is your desired outcome?

Restore my smile
Improve my chewing function
Both
Other

Dental Implant procedures are not covered by insurance. However, many affordable payment plans are available. Are you interested in a payment plan option?

Yes. I'm interested in affordable payment plan options.
No. I've been saving for this type of procedure and will not need a payment plan.

Which of the options below most accurately represents your current credit score?

Excellent (750 and above)
Good (650-749)
Fair (600-649)
Poor (Under 599)

desired payment your

Do you own your home?

Yes
No

Which best describes your current household monthly income?

Over $8,000
$4,000 to $8,000
Under $4,000

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