1. Hi, what is your name?
2. How many teeth are you missing? I am missing 1-4 teethI am missing 5-8 teethI am missing 9-12 teethI am missing nearly all of my teethI have no teeth left/I wear denturesOther – Please Explain (optional)
3. How serious are you about getting dental implants? Just researching and looking at optionsVery interested and looking at 2nd opinionsVery serious – I am getting implants in the next 60 daysOther – Please Explain (optional)
4. Our dental implant options range from $2,999. What best describes your ability to pay for dental implants? I am aware of the costs but can’t pay for them right now.I can pay the full amount up frontI would consider a payment plan if implants are right for meOther – Please Explain (optional)
5. What is the best way to reach you? By phone or email? PhoneEmail
6. What’s the best phone number to reach you at?
7. What is the best email to reach you at?
8. When is the best time to reach you? MorningMid-day/AfternoonEvening
9. Would you like a personalized information package sent to you? YesNo
10. Lastly, do you have any questions?
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