Questions That Will Change Your Life

  1. Are you currently experiencing dental pain or discomfort?
    Yes
    No
    Sometimes
  2. Are You Having Problems with a Single Tooth, Multiple Teeth or Are You Having Problems with More than 3 Teeth?
    Single Tooth
    Multiple Teeth
    3 or more teeth
  3. What Type of Foods Can You Comfortably Eat All the Time? (Check all that apply)
    Soft (Ex: Eggs, Mashed Potatoes)
    Medium (Ex: Bread, Cereal)
    Hard (Ex: Salad, Apple, Steak, Corn-on-the-Cob)
  4. Are Your Teeth Affecting Your Job?
    Yes
    No
    Sometimes
  5. Are Your Teeth Affecting Your Social Interactions?
    Yes
    No
    Sometimes
  6. Are You Currently Wearing a Denture?
    No
    Partial Denture
    Full Denture
  7. Have You Seen a Dentist About Your Dental Condition?
    No
    General Dentist
    Specialist
  8. How Would Finding a Permanent Solution to Your Dental Problems Make You Feel?
  9. Fill Out the Form Below and We Will Contact You with Answers to Your Quiz.
Your request has been sent -- we will be in contact with you shortly.
There was an error! Please phone our office.