Our Dental Implant Survey | Smile Science Dental Spa | Smile Science Dentures & Implants

20118 N. 67th Ave #308, Cave Creek, AZ 85308

Schedule Free Consultation

(480) 530-3663

20118 N. 67th Ave #308, Cave Creek, AZ 85308

Book Now

Main Menu

Home
Implants
Our Practice
Financing
Am I A Candidate?

Find out if you're a candidate

Fill out the survey to help us learn more about you and your goals.

Implant Survey

- Step 1 of 16

What best describes your condition? *

I have all of my teeth
I'm missing a couple of teeth
I'm missing multiple teeth
I'm missing all of my teeth

How long have you been missing your teeth? *

Less than one year
1-5 years
5+ years

What dental treatments have you had before? *

Bridges
Partial dentures
Complete dentures
Dental implants
None of the above

Dentures Location *

Top teeth
Bottom teeth

Do you experience insecurities from the appearance of your teeth? *

Does the condition of your teeth affect your ability to eat specific foods? *

Which treatment outcome is your priority? *

Function - Eating, Chewing, Speaking
Esthetics - Natural, Beautiful Teeth
Both are equally important

What is the biggest obstacle to getting the treatment you want? *

Cost of treatment
Fear of treatment
Finding the time
Finding the right dentist

How urgently do you want to begin treatment? *

Immediately
In the next 1-3 months
I'm not in a hurry

Have you seen other doctors about this treatment before? *

Are you the primary decision maker for your healthcare needs? *

Dental implant procedures are not usually covered by dental insurance. We offer affordable payment plans to help you get the care you need. Are you interested in a payment plan? *

I am interested in a payment plan
I have saved money for this procedure and don't need a payment plan
I already have help and won't need a payment plan

What would you be comfortable paying each month to achieve your goals? *

Credit History *

Great (700+)
Good (630-700)
Poor (Less than 630)

If you require financial assistance, please select the option that best describes your credit score.

Do you have a source of income? *

If you are looking to finance your dental treatment, healthcare financing companies will ask for a source of income. Do you have a job or other source of income?

Do you have a co-signer? *

Do you already have a co-signer who will be helping you afford dental implants?

Which Option Fits Your Budget Best? *