Am I a candidate for Natural Teeth™? Schedule Your Free Consultation 30-second assessment to see if Natural Teeth™ is right for you and to schedule your Free Consutation Name* First Last Phone Number*Ex. (904) ###-####Email* I would like to…* Replace Missing Teeth/Tooth Fix Cracked/Worn Out Teeth Get Rid Of The Pain In My Teeth Have A Perfect Smile Find Out My Options Why are you taking this first step to correct your dental health?* I am in pain I have lost confidence in my smile I am unable to chew I have waited so long and it is time All of the above - I'm in pain, lack confidence, & cannot chew What type of dental implant solution are you interested in?* Full Fixed Arch Implants - I want the best quality full mouth restoration possible, even if it's more expensive Implant Retained Dentures - I want an implant denture hybrid. I'm looking to balance quality with price Implant Bridge - I want to replace just a few missing teeth in a row Single Dental Implant - I'm missing one or two single teeth that need to be replaced I am open to doctor suggestions If this is your second consultation please explain why you would like a second opinion?* This is my first consultation I did not feel confident/comfortable in the doctor at the other practice I would like to compare prices Cost was an issue On a scale 1-10, how urgent is this treatment to you? 1=this is not a priority 10=ready to find a solution now* 10 9 8 7 6 5 4 3 2 1 What is the most important to you when selecting a dental health provider?* Financing Options Experience & Level Of Expertise Flexibility Of Appointment Times Price Sedation Options Dental implant treatment may require a substantial financial investment. Have you planned on how you will pay for the work needed?* I have good credit and would like financing arrangements I will pay out of pocket I do not have great credit and will need other financial assistance I have not given thought to this Are you interested in financing options* Yes No Maybe If you require financing, please select the option below that best describes your credit history.*Please tell us what category you are in - the better your credit score is the more likely you are to get approved for financing. Poor Credit (Under 650) Average Credit (650-700) Good Credit (700-750) Great Credit (750+) If you are looking to finance your dental treatment, healthcare financing companies will ask for a source of income. Do you have a job / source of income?* Yes, I have a job/source of income No, I don't have a job/source of income I do have a cosigner How did you hear about us?*SelectFriend or familyMy dentist referred meGoogle/web searchBillboardTV/RadioSocial Media
