Dental Implants Survey – New Smiles Dentistry

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Which best describes your current situation?*

I'm missing a SINGLE tooth

I'm missing MULTIPLE teeth

I have loose or uncomfortable dentures

Most of my teeth are damaged or decayed

Do you currently have any of these dental solutions?*

I have a denture or partial denture

I have a bridge or crown

I have a dental implant

None of the above

How long have you been missing teeth?*

I still have all my teeth

6 months

More than 1 year

More than 5 years

Do you have trouble chewing certain foods?*

Yes

No

Are you currently having pain or discomfort?*

Yes

No

Do you lack confidence in your smile?*

Yes

No

Are you interested in financing options?*

Yes, I need financing options

No, I don't need a payment plan

How ready are you to restore your smile?*

I'm exploring options

I'm ready to get started!

Are you already a New Smiles patient?*

Yes

No

Please let us know how to reach you:

Name*

Email*

Phone*