Surgical Expertise Matters When It Comes To Dental Implants

Submit The Dental Implant Evaluation So We Can learn more about your condition

Why Choose an Oral Surgeon for Dental Implants

Reduce the risk of complications
Extremely high success rates
Substantial training beyond dental school
Advanced surgical techniques
Comprehensive care
Expert in complex cases
Safe & comfortable surgeries
Better aesthetic results

Choosing an oral surgeon for your dental implants is essential.

We've covered it all,

You just have to show up!

Submit The Dental Implant Evaluation So We Can learn more about your condition

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

Currently Have Denture/Bridge

How Long Have You Been Missing Your Teeth? *

Less than a year

1 - 3 Years

5+ Years

Are you currently wearing dentures? *

Yes

No

What made you reach out to our office? *

Missing Teeth

Damaged Teeth

Cosmetic Reasons

Replacing Current Dentures

Select All That Apply - Do You Feel That Tooth Loss Has Affected Your: *

Personal Life (Relationships, Social Interactions)

Professional Life (Confidence at work, Career Opportunities)

Enjoyment of Food (Savoring your favorite meals)

Physical Comfort (Pain, Discomfort)

Appearance/Self-Confidence (How you feel about yourself and your smile)

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

Yes

No

What Is The Most Important Outcome You Are Seeking? *

Function - Eating, Chewing, Talking

Aesthetics - Beautiful, Natural Looking Teeth

Both Are Equally As Important

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. *

What is your timeline to receive treatment? *

Very little, I'm in no rush

Moderate, Within 1-3 months

High, I need help now

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

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

Yes

No

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 *

No Financing

$50-149/Month

$150-$249/Month

$250-349/Month

Over $350/Month

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

For your convenience, we will send you the customized information in regards to pricing for dental implants via text and email *

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. *

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 *

Last Name *

Phone *

Email *

Postal Code *

Our practice is located in Clearwater, FL. Are you willing to travel to this location? *

Yes, I will be there!

No, you are too far away

NEXT

I understand that by hitting "Submit" I am opting into receiving text, emails, and phone calls relating to booking a dental implant consultation. Also the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act.

Submit The Dental Implant Evaluation So We Can learn more about your condition

When You Complete The Dental Implant Evaluation, You Will Instantly Discover:

If You are A Candidate For
Dental Implants
What treatment options
are available for you
Pricing & financing options

And You'll Immediately Be Connected With Our Patient Advocate!

(727) 615-4312

2963 Gulf to Bay Blvd, Suite 270

Clearwater, FL 33602

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