Candidate for ImplantsFind out if you're a candidate for Implants. Answer the following questions to learn more about Implants atBlue Door Dental Or call us at 626.618.9394 Step 1 of 9 11% What best describes your condition?(Required) I have all of my teeth I'm missing one tooth I'm missing multiple teeth I'm missing all of my teeth How long have you been missing your teeth?(Required) I'm not missing any teeth Less than a year More than a year Do you currently have any of the following?(Required) Crown(s) Bridge(s) Partial(s) Full denture(s) None of the above Do you have any insecurities with the way your teeth look?(Required) Yes No 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?(Required) Function - eating, chewing, talking Aesthetics - beautiful, natural looking teeth Both are equally as important What has been the most significant factor in preventing you from getting your treatment?(Required) Time Money Fear Haven’t found the right dentist How soon are you planning to have dental implants placed?(Required) More than 3 months from now 1-3 months from now As soon as possible Patient Full Name(Required)Email(Required) Phone(Required)Message(Required) Δ Questions?Phone 626.618.9394 © Blue Door Dental 2023
