Dental Implant Questionnaire

Dentistry for Life

Fill out this questionnaire to find out if you're a candidate for dental implants!

1. Which best describes how you feel?(Required)
2. Which best describes your present situation?(Required)
3. Do you have a denture? If no, answer "not applicable" on #4.(Required)
4. My dentures:(Required)
5. Do you have any insurance coverage for dental implants?(Required)
6. Can you participate/contribute to a flexible spending account?(Required)
7. If everything works out, when would you like to start dental implant treatment?(Required)
8. How much research have you done?(Required)
9. The following apply to me:(Required)
10. Contact Information(Required)