Quiz - Britely

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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.

How many teeth are missing? *

All
6 or More
4-5
3 or Less
I have all of my teeth

How long have you been missing your teeth? *

Less than a month
1-6 months
6-12 months
More than a year

Do you currently have any of these dental implant solutions? *

Denture(s) or Partial Denture(s)
Bridge or Crowns
Dental Implants
None of the above

What is your age? *

Over 60
50-59
40-49
30-39
Under 30

Do you have difficulty eating your favorite foods? *

Are you currently experiencing any dental pain or discomfort? *

Are you lacking confidence in social situations or do you find yourself hiding your smile? *

How 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)

What 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 sure

Dental 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 options
No, I have other ways to pay for the procedure

Please let us know if there's anything else you'd like to share.

First Name

Last Name

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Confirm Email

Which Location would you most interested in visiting for a Consultation? *

Would 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.

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