90-Second Dental Implant Eligibility Quiz Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Take our quiz to see if you are a candidate for dental implants We are focused on the removal and replacement of natural teeth with Dental Impants and/or Dentures. Due to the overwhelming demand for our services, we can’t help everyone. Take our quiz to determine if you are eligible for the services that we provide. NextHow many teeth are missing? *All6 or More4-53 or LessI have all of my teethNextHow long have you been missing your teeth? *Less than a month1-6 months6-12 monthsMore than a yearNextDo you currently have any of these dental implant solutions? *Denture(s) or Partial Denture(s)Bridge or CrownsDental ImplantsNone of the aboveNextWhat is your age? *Over 6050-5940-4930-39Under 30NextDo you have difficulty eating your favorite foods? *YesNoNextAre you currently experiencing any dental pain or discomfort? *YesNoNextAre you lacking confidence in social situations or do you find yourself hiding your smile? *YesNoNextHow soon would you like to address your current situation? *I need something fast (Next few days)Very ready (Next 30 days)Somewhat ready (Exploring options)Just looking (Trying to learn more)NextWhat option do you feel you'd be interested in? *Denture(s)Dental Implant(s) (1-3)Full Mouth Restoration (Upper, Lower or Both)I’m not sureNextDental Implants procedures are not fully covered by dental insurance. However, affordable payment options may be available. Are you interested in a payment plan option? *Yes, I am interested in payment plan optionsNo, I have other ways to pay for the procedureNextPlease let us know if there's anything else you'd like to share.NextFirst NameLast NameAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *EmailConfirm EmailWhich Location would you most interested in visiting for a Consultation? *Select a LocationAZ – North ScottsdaleAZ – SurpriseCO – DenverFL – Fort Myers / Bonita SpringsFL – SarasotaMN – Golden Valley / W. MinneapolisMN – Oakdale / WoodburyWI – Milwaukee / GreendaleWould you like to send us a picture of your current smile? Click or drag files to this area to upload. You can upload up to 2 files. Submit