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1. What is the number one concern that you’re having with your teeth right now?
I'm missing 1-2 teeth
I’m missing more than 2 teeth
I want to get rid of my denture
I need to have 1 or more teeth removed
2. What has stopped you from fixing this problem?
I haven’t found a dentist I trust
I haven’t made the time
The solutions I’ve found are too expensive
3. What would be the biggest benefit if we could help you fix this problem?
I could smile with confidence again.
I could eat normally again.
My teeth wouldn’t hurt anymore.
4. If you could fit implants into your budget are you ready to start right away?
Yes
No
5. Are you interested in finding out if dental implants are a good option for you?
Yes
Not at this time
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Village Dental at Saxony
13390 Overview Dr., Fishers, IN 46037
317-565-4249
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