Am I a candidate for Natural Teeth™? 30-second assessment to see if Natural Teeth™ is right for you. What implant option are you interested in?* Full upper teeth replacement Full lower teeth replacement Full mouth teeth replacement (upper and lower) Just a couple of teeth to replace Do you wear partial or full dentures?* Full denture Partial denture Just missing some teeth No missing teeth How long have you been wearing a removable denture?* 0-5 years 6-10 years 10+ years Diabetes history* Diabetic, under good control Diabetic, uncontrolled No diabetes Have you had an implant consult in the past?* Yes, I was a good candidate Yes, but I needed bone grafting Yes, but it was a long time ago No, this will be my first time Smoking history* Smoke or vape (cigarettes or marijuana) Former smoker or vape Never smoke or vape When making a large purchase, what is most important to you?* Reputation Price Warranty Look and style Select your tooth wear pattern* Mild or no wear Moderate wear Severe wear Do you have cavities or broken teeth?* Cavities Broken teeth Cavities and broken teeth Not that I am aware of Do you have gum or periodontal disease?* Gum recession Mild to moderate gum disease Severe gum disease No gum disease Name* First Last Phone Number*Ex. (904) ###-####Email* How did you hear about us?*SelectFriend or familyMy dentist referred meGoogle/web searchBillboardTV/RadioSocial Media
