Are you able and willing to travel to Kenner, Louisiana? Address: 3701 Williams Blvd. #253 Kenner, LA 70065 *

Yes

Which condition best describes you? *

1 tooth is missing or needs to be pulled

Multiple teeth are missing or need to be pulled

I'm struggling with traditional dentures

Most of my teeth are in pretty bad condition

How long have your teeth been missing? (The longer your teeth are missing, the more your jaw bone shrinks.) *

I Still Have Them

1-3 Months

3-6 Months

6 Months - 1 Year

More than 1 Year

Do you currently have any of these dental solutions? *

Dentures or Partial Dentures

Bridge / Crown

Dental Implant

None of the above

Why are you taking this first step to correct your dental health? *

I am in pain

I have lost confidence in my smile

I am unable to chew

All of the above - I'm in pain, lack confidence, & cannot chew

What is the most important factor that has prevented you from getting treatment? *

Time

Money

Fear

Can't Find The Right Dentist

Patients without teeth lose as much as 25% of their bone width within the first year. The longer you wait to replace missing teeth, the more advanced your bone loss will become.

How urgently are you seeking relief from any pain or discomfort you're currently experiencing? *

1 - Not urgent, I’m in no rush

2 - Somewhat urgent, within the next 1–3 months

3 - Very urgent, I need help as soon as possible

What type of dental implant solution are you interested in? *

Full Fixed Arch Implants - I want the best quality full mouth restoration possible, even if it's more expensive.

Implant Retained Dentures - I want an implant denture hybrid. I'm looking to balance quality with price.

Implant Bridge - I want to replace just a few missing teeth in a row.

Single Dental Implant - I'm missing one or two single teeth that need to be replaced.

Would you like to explore our simple monthly payment options? If so, what monthly amount feels comfortable for you? *

I’m not interested in financing

$150–$249 per month

$250–$349 per month

Over $350 per month

Financing approval is based on credit history. How would you describe your credit score? *

Poor (Below 580)

Fair (580–650)

Good (650–720)

Excellent (720+)

If needed, would you have a co-signer available to help with financing approval? *

Yes

If you plan to use a co-signer, how would you describe their credit score? *

Poor (Below 580)

Fair (580–650)

Good (650–720)

Excellent (720+)

Full Name *

Email *

Phone *