Find Out If You're A
Candidate For Dental Implants!

Answer The Following Questions To Learn More About Our Pricing & Financing Options

What Best Describes Your Condition? *

I Have All My Teeth

I'm Missing One Tooth

I'm Missing Multiple Teeth

I'm Missing All My Teeth

How Long Have You Been Missing Your Teeth? *

I'm Not Missing Teeth

Less Than A Year

More Than A Year

Are you currently wearing dentures? *

Yes

Select all that apply - Do you feel that tooth lose has affected your: *

Personal Life

Professional Life

Enjoyment of Food

Physical Comfort

Oral Health

Appearance/Self Confidence

What Is The Most Important Factor That Has Prevented You From Getting Treatment? *

Time

Money

Fear

Can't Find The Right Dentist

Please Describe your current Oral Health situation and the challenges that you are Experiencing. *

Have you seen another dentist about your condition? *

No, This is my first consultation

Yes, I did not feel comfortable with the other practice

Yes, I'm looking to compare pricing

If this is a second opinion what type of implant solution are you looking for? *

Fixed Full Arch

Implant Supported Denture

Single Implant

Traditional Denture

Not Sure

Most Dental Implant procedures are not covered by insurance. However we offer many payment plans that make it quite affordable and offer low monthly rates. Are you interested in a payment plan? *

Yes I am!

No I will not need a payment plan

Are You Interested in Learning About Our Easy Monthly Payment Plans? If So, What Dollar Range Would You Like To Pay Monthly (Upon Approval Third Party Financing) *

No, I will not need a payment plan

$150-$249/Month (For Single Implant)

$250-349/Month

Over $350/Month

Some medical insurance plans may cover Full-Arch dental implant treatment. Do you have a medical insurance plan? *

Metlife PPO

BCBS PPO

Delta PPO

Other

No, I do not have Medical Insurance

First Name *

Last Name *

Mobile (Cell) Number *

Email *

Postal Code *

Find Out If You're A
Candidate For Dental Implants!

Answer The Following Questions To Learn More About Our Pricing & Financing Options

What Best Describes Your Condition? *

How Long Have You Been Missing Your Teeth? *

Are you currently wearing dentures? *

What made you reach out to our office? *

Select all that apply - Do you feel that tooth lose has affected your: *

Does Your Condition Have A Negative Impact On Your Ability To Eat or Chew Certain Foods? *

What Is The Most Important Outcome You Are Seeking? *

What Is The Most Important Factor That Has Prevented You From Getting Treatment? *

Please Describe your current Oral Health situation and the challenges that you are Experiencing. *

What is your timeline to receive treatment? *

Have you seen another dentist about your condition? *

If this is a second opinion what type of implant solution are you looking for? *

Are You The Decision Maker In Regards To Your Dental & Healthcare? *

Most Dental Implant procedures are not covered by insurance. However we offer many payment plans that make it quite affordable and offer low monthly rates. Are you interested in a payment plan? *

Are You Interested in Learning About Our Easy Monthly Payment Plans? If So, What Dollar Range Would You Like To Pay Monthly (Upon Approval Third Party Financing) *

Some medical insurance plans may cover Full-Arch dental implant treatment. Do you have a medical insurance plan? *

How Familiar are you with the "All-On-4" treatment? Scale of 1-10 *

Burr Ridge Office

Mount Prospect Office

Roselle Office

Find Out If You're A Candidate For Dental Implants!

Answer The Following Questions To Learn More About Our Pricing & Financing Options

What Best Describes Your Condition? *

How Long Have You Been Missing Your Teeth? *

Are you currently wearing dentures? *

What made you reach out to our office? *

Select all that apply - Do you feel that tooth lose has affected your: *

Does Your Condition Have A Negative Impact On Your Ability To Eat or Chew Certain Foods? *

What Is The Most Important Outcome You Are Seeking? *

What Is The Most Important Factor That Has Prevented You From Getting Treatment? *

Please Describe your current Oral Health situation and the challenges that you are Experiencing. *

What is your timeline to receive treatment? *

Have you seen another dentist about your condition? *

If this is a second opinion what type of implant solution are you looking for? *

Are You The Decision Maker In Regards To Your Dental & Healthcare? *

Most Dental Implant procedures are not covered by insurance. However we offer many payment plans that make it quite affordable and offer low monthly rates. Are you interested in a payment plan? *

Are You Interested in Learning About Our Easy Monthly Payment Plans? If So, What Dollar Range Would You Like To Pay Monthly (Upon Approval Third Party Financing) *

Some medical insurance plans may cover Full-Arch dental implant treatment. Do you have a medical insurance plan? *

How Familiar are you with the "All-On-4" treatment? Scale of 1-10 *

Burr Ridge Office

Mount Prospect Office

Roselle Office

Please Choose Your Preferred Location

Find Out If You're A
Candidate For Dental Implants!