Same Day Dental Implants in Corsicana TX

Which Condition Best Describes You?(Required)

Missing 1 Tooth

Missing Multiple Teeth

Struggling With Traditional Dentures

Most Of My Teeth Are In Pretty Bad Shape

How Many Teeth Are You Currently Missing?(Required)

All

6+

4-5

3 or Less

Do You Have Several Loose Teeth Or Been Diagnosed With Periodontal Disease?(Required)

Yes

No

What Is Your Age?(Required)

60+

50-59

40-49

<40

Do you currently have any of these dental solutions?(Required)

Denture or Partial Denture

Bridge, Crown

Dental Implant

None of the above

How Long Have You Been Missing Your Teeth?(Required)

(The longer teeth are missing the more the jaw bone shrinks)

I Still Have Them

1-6 Months

7-12 Months

1+ Years

Are You Currently Unable To Eat Certain Foods Or Have To Modify The Way You Chew?(Required)

Yes

No

Are You Currently Trying To Find Relief From Any Kind Of Pain Or Discomfort?(Required)

Yes

No

Are You Currently Experiencing A Lack Of Confidence In Social Situations or Find Yourself Hiding Your Smile?(Required)

Yes

No

Have You Had A Dental Implant Consultation With Another Dentist?(Required)

Yes

No

How Ready Do You Feel To Do Something About Your Situation?(Required)

Somewhat Ready

Very Ready

I Need Something FAST!

Dental Implant procedures are not covered by insurance. However, many affordable payment plans are available. Are you interested in a payment plan option?(Required)

Yes. I'm interested in affordable payment plan options

No. I've been saving for this type of procedure and will not need a payment plan

Payment plans are available based on credit approval of the patient or a co-signer. Which best describes your credit?(Required)

Under 500

520-649

660-749

750+

Which best describes your current monthly income?(Required)

Under $4,000

$4,000 to $8,000

Over $8,000

What range of monthly payments can you afford?(Required)

Below $250

$250 - $500

$500 - $800

Unable to afford monthly payments

How much have you set aside for your dental treatment?(Required)

$50,000+

$25,000 - $50,000

$15,000 - $25,000

$5,000 - $15,000

Less than $5,000

Do you own your own home?(Required)

Yes

No

Medical Insurance:(Required)

Blue Cross Blue Shield HMO

Blue Cross Blue Shield PPO

Medicaid

Medicare

Other

None

What Is Your Name?(Required)

First Last

What Is Your Best Email Address?(Required)

What Is Your Best Phone Number?(Required)

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