(737) 637-3722
701 FTM 685, Suite #150-155
Pflugerville, TX 78660
Find Out If You're A
Candidate For Dental Implants
*Full Arch Solutions are available with monthly installments as low as $299
Answer The Following Questions To Learn More About Our Pricing And Financing Options.
What made you reach out to our office?
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Tooth Pain
Missing Teeth
Insecurities about the way you look
All of the above
What Best Describes Your Condition?
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I Have All My Teeth
I'm Missing One Tooth
I'm Missing Multiple Teeth
I'm Missing All My Teeth
Select all that apply - Do you feel that tooth lose has affected your:
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Personal Life
Professional Life
Enjoyment of Food
Physical Comfort
Oral Health
Appearance/Self Confidence
Are you currently wearing dentures?
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Yes
No
What is your timeline to receive treatment?
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Very little, I'm in no rush
Moderate, Within 1-3 months
High, I need help now
How Familiar are you with the "All-On-4" treatment? Scale of 1-10
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Have you seen another dentist about your condition?
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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?
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Fixed Full Arch
Implant Supported Denture
Single Implant
Traditional Denture
Not Sure
Dental implants contribute to your overall well-being and are worth the investment. Have you looked into the out-of-pocket expenses associated with this treatment?
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Yes
No
Given that dental implants are an elective procedure, insurance coverage may only extend to a portion of the treatment costs. Could you please share your current credit score status to better assist you?
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500- 550
551 - 600
601 - 650
651 - 700
701+
I don't know my credit score
Do you have anyone you can bring along with you for the consultation to assist you with this investment?
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Yes
No
Please Describe your current Oral Health situation and the challenges that you are Experiencing.
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Do you consent to receive texts and emails regarding Dental Implant treatments and the prices associated?
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Yes send me the information
No, I do not wish to receive information regarding pricing for dental implants
By selecting no, we want to make sure that you are aware that we will not be able to provide you with the pricing and information you have requested regarding Dental Implants, immediately. We will reach out via a phone call but if you would like an email and text regarding pricing, please opt-in below.
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Yes I consent to receive this information
I would like to schedule an appointment to talk in person
I would like to speak to someone via phone call to discuss
I do not want this information
First Name
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Last Name
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Phone
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Email
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Postal Code
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Our practice is located in Pflugerville, TX. Are you willing to travel to this location?
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Yes
No
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