Describe the condition of your teeth
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My teeth are chipped/ broken
My teeth are discolored
My teeth are smaller than average
I have excessive gaps between my teeth
My teeth are worn down
How many of your teeth need veneers?
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1 to 3
Mainly just one row of teeth
Most/all of my teeth need work
What best describes your reason for looking into veneers?
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I am embarrassed about my smile
I want a beautiful smile
I know someone who has veneers and they look AMAZING!
Veneers may not be covered by insurance. However, many affordable payment plan options exist. Are you interested in a payment plan option?
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Yes. I'm interested in affordable payment plan options
No. I will not need a payment plan
Payment plans are available based on credit approval of the patient or a co-signer. Which best describes your credit?
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(Very Poor) Under 500
(Poor) 501-600
(Good) 601-649
(Very Good) 650-699
(Excellent) 700+
I don't know
Based on your credit score you may not qualify for financing without a co-signer. Do you have someone with good credit history who would co-sign with you?
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Yes
No
Unfortunately it looks like you would not be able to qualify for our payment plan options. Do you have any other way to pay for a Dental Implant procedure?
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Savings
Credit Card
Retirement Account (401k, etc)
Other loan (Home Equity, etc)
Help from a relative
No, I don't
How Ready Do You Feel To Do Something About Your Situation?
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Somewhat Ready
Very Ready
I Need Something FAST!
Have you ever had a Veneer consultation before?
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Yes
No
What Is Your Name?
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What Is Your Best Email Address?
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What Is Your Best Phone Number?
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