How Many Missing Or Broken Teeth Do You Have?*

All

4 Or More

3 Or Less

Have You Been Diagnosed With Periodontal Disease or Have Several Loose Teeth?*

Yes

No

Select the option below that best fits your situation*

I want to replace ALL my teeth with new permanent teeth

I want to replace my upper or lower set of teeth

I only want to have a couple teeth replaced

I don't want any of my teeth replaced

What Is Your Age?*

55 and older

40-54

Under 40

Do you currently have any of these dental treatments?*

Dentures

Crowns and/or Bridges

Dental Implant

None of the above

How Long Have You Been Missing Your Teeth?*

I Still Have Them

1-4 Months

4-12 Months

1 or more Years

Do you Have To Modify The Way You Chew or Are You Currently Unable To Eat Certain Foods?*

Yes

No

Are You Currently Trying To Find Relief From Any Kind Of Pain Or Discomfort?*

Yes

No

Are You Embarrassed Or Hiding Your Smile?*

Yes

No

Have You Had A Dental Implant Consultation With Another Dentist?*

Yes

No

How Ready Are You To Do Something About Your Situation?*

I am ready NOW!

Very ready

Not sure I am ready

Dental Implant procedures are not covered by insurance. Our full arch implants begin around $20,000. We have payment plans averaging $300/mo. Would you like to see if you qualify for a payment plan, or continue without?*

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

What Is Your First Name?*

What Is Your Last Name?*

What Is Your Zip Code?*

Please enter a number from 1000 to 99999.

What Is Your Email?*

What Is Your Phone Number?*

Name

This field is for validation purposes and should be left unchanged.

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Runion Dental Group