Survey ADTMJ

Are you a new or existing patient?

New PatientExisting Patient

Which of the following best describes your situation?

I’m missing most or all of my teethI wear dentures or am about toI’m struggling with multiple failing or broken teethI’m not sure, but I want a long-term solution

What would you most like to improve with dental implants?

(Select all that apply) Eat comfortably againImprove my smile appearanceFeel more confident sociallyReplace missing or damaged teethStop dealing with dentures or discomfort

How soon are you looking to come in?

ASAPWithin 1 weekWithin 2 weeksMore than 2 weeks

Are You Looking For Monthly Payment Options For Dental Implants?

YesNo

Sure! We Have Affordable Payment Options, How Is Your Credit Score?

Above 600Below 600

Credit Guidance

Based on your response, we recommend applying with a co-signer to increase your chances of approval.

Many of our patients with lower credit scores are successfully approved when applying with a co-signer.

Are you ready to book your appointment now?

YesNo

Contact Details

Please provide your contact details to complete your appointment booking.

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested from Advanced Dental Implant and TMJ Center. These messages may include appointment confirmations, reminder and followups among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt out.By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, and new service updates, among others, from Advanced Dental Implant and TMJ Center. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt out.

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Midsouth’s #1 Choice for Dental Implants