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CUSTOM JAVASCRIPT / HTML
1. Which condition best describes you?
Missing 1 Tooth
Missing Multiple Teeth
Struggling With Traditional Dentures
Most Of My Teeth Are In Pretty Bad Shape
2. Do you currently have any of these dental solutions?
Denture or Partial Denture
Bridges, Crowns
Dental Implants
None of the above
3. How long have you been missing your teeth?
(The longer teeth are missing the more the jaw bone shrinks)
I Still Have Them
1-3 Months
3-6 Months
6 Months to 1 Year
1 Year +
4. Are you currently unable to eat certain foods or have to modify the way you chew?
Yes
No
5. Are you currently trying to find relief from any kind of pain or discomfort?
Yes
No
6. Are you currently experiencing a lack of confidence in social situations or find yourself hiding your smile?
Yes
No
7. How soon are you looking to do something about your situation?
I'm Ready Now
Within The Next Few Months
Longer Than A Few Months
I'm Just Starting My Research, And I'm Not Sure When I'll Be Ready
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