smiledentalcenter.implant-evaluation.com
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2606:4700::6812:1759
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URL:
https://smiledentalcenter.implant-evaluation.com/
Submission: On October 31 via api from US — Scanned from US
Submission: On October 31 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
Name: builder-form —
<form id="_builder-form"
style="background-color:#FFFFFF;color:#undefined;border:4px solid #000000FF;border-radius:25px 25px 0 0;max-width:750px;width:100%;margin-top:;border-color:#000000FF;padding-top:0px;padding-bottom:0px;padding-left:20px;padding-right:20px;box-shadow:0;margin-bottom:0;"
name="builder-form" class="ghl-survey-form" data-v-d9fad203=""><!---->
<div class="ghl-question-set" style="margin-top:2px;" data-v-d9fad203=""><!--[-->
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<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">What condition best describes you? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="1 Tooth Is Missing or Needs Pulled_Tb22OQQa4IG0OXbCS8EJ_0_k1nlmyoek6" value="1 Tooth Is Missing or Needs Pulled" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="1 Tooth Is Missing or Needs Pulled_Tb22OQQa4IG0OXbCS8EJ_0_k1nlmyoek6">1 Tooth Is Missing or Needs Pulled</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Multiple Teeth Are Missing or Need Pulled_Tb22OQQa4IG0OXbCS8EJ_1_k1nlmyoek6" value="Multiple Teeth Are Missing or Need Pulled" type="radio"
data-required="true"><label style="margin-left:10px;margin-bottom:0;" for="Multiple Teeth Are Missing or Need Pulled_Tb22OQQa4IG0OXbCS8EJ_1_k1nlmyoek6">Multiple Teeth Are Missing or Need Pulled</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I'm Struggling With Traditional Dentures_Tb22OQQa4IG0OXbCS8EJ_2_k1nlmyoek6" value="I'm Struggling With Traditional Dentures" type="radio"
data-required="true"><label style="margin-left:10px;margin-bottom:0;" for="I'm Struggling With Traditional Dentures_Tb22OQQa4IG0OXbCS8EJ_2_k1nlmyoek6">I'm Struggling With Traditional Dentures</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Most of My Teeth are In Pretty Bad Condition_Tb22OQQa4IG0OXbCS8EJ_3_k1nlmyoek6" value="Most of My Teeth are In Pretty Bad Condition" type="radio"
data-required="true"><label style="margin-left:10px;margin-bottom:0;" for="Most of My Teeth are In Pretty Bad Condition_Tb22OQQa4IG0OXbCS8EJ_3_k1nlmyoek6">Most of My Teeth are In Pretty Bad Condition</label></div>
</div><!--]-->
</div>
</div><!----><!----><!---->
</div><!---->
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</div><!--]-->
</div>
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<div class="slide-no-2 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">Do you currently have any of these dental solutions? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Denture or Partial Denture_MtPVUsColMPVXD3byrrw_0_k1nlmyoek6" value="Denture or Partial Denture" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="Denture or Partial Denture_MtPVUsColMPVXD3byrrw_0_k1nlmyoek6">Denture or Partial Denture</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Bridge/ Crown_MtPVUsColMPVXD3byrrw_1_k1nlmyoek6" value="Bridge/ Crown" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="Bridge/ Crown_MtPVUsColMPVXD3byrrw_1_k1nlmyoek6">Bridge/ Crown</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Dental Implant_MtPVUsColMPVXD3byrrw_2_k1nlmyoek6" value="Dental Implant" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="Dental Implant_MtPVUsColMPVXD3byrrw_2_k1nlmyoek6">Dental Implant</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="None of the Above_MtPVUsColMPVXD3byrrw_3_k1nlmyoek6" value="None of the Above" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="None of the Above_MtPVUsColMPVXD3byrrw_3_k1nlmyoek6">None of the Above</label></div>
</div><!--]-->
</div>
</div><!----><!----><!---->
</div><!---->
</div>
</div><!--]-->
</div>
</div>
<div class="slide-no-3 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">How long have your teeth been missing? (The longer your teeth are missing, the more your jaw bone shrinks.)
<span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I Still Have Them_WaOyFl7lzkccWaocLNlc_0_k1nlmyoek6" value="I Still Have Them" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="I Still Have Them_WaOyFl7lzkccWaocLNlc_0_k1nlmyoek6">I Still Have Them</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="1-3 Months_WaOyFl7lzkccWaocLNlc_1_k1nlmyoek6" value="1-3 Months" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="1-3 Months_WaOyFl7lzkccWaocLNlc_1_k1nlmyoek6">1-3 Months</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="3-6 Months_WaOyFl7lzkccWaocLNlc_2_k1nlmyoek6" value="3-6 Months" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="3-6 Months_WaOyFl7lzkccWaocLNlc_2_k1nlmyoek6">3-6 Months</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="6 Months - 1 Year_WaOyFl7lzkccWaocLNlc_3_k1nlmyoek6" value="6 Months - 1 Year" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="6 Months - 1 Year_WaOyFl7lzkccWaocLNlc_3_k1nlmyoek6">6 Months - 1 Year</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="More than 1 Year_WaOyFl7lzkccWaocLNlc_4_k1nlmyoek6" value="More than 1 Year" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="More than 1 Year_WaOyFl7lzkccWaocLNlc_4_k1nlmyoek6">More than 1 Year</label></div>
</div><!--]-->
</div>
</div><!----><!----><!---->
</div><!---->
</div>
</div><!--]-->
</div>
</div>
<div class="slide-no-4 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">What would be the biggest life change that we could help you experience by fixing this problem? (Check all that
apply.) <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;">
<div class="in-r-c"><input id="I could eat the foods I want to again!_w6MlSJmg82A5hPUNlKIc_0_k1nlmyoek6" value="I could eat the foods I want to again!" name="I could eat the foods I want to again!" type="checkbox"
data-required="true"><label style="margin-left:10px;" for="I could eat the foods I want to again!_w6MlSJmg82A5hPUNlKIc_0_k1nlmyoek6">I could eat the foods I want to again!</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;">
<div class="in-r-c"><input id="I could smile with confidence again and never be embarrassed in social situations!_w6MlSJmg82A5hPUNlKIc_1_k1nlmyoek6"
value="I could smile with confidence again and never be embarrassed in social situations!" name="I could smile with confidence again and never be embarrassed in social situations!" type="checkbox" data-required="true"><label
style="margin-left:10px;" for="I could smile with confidence again and never be embarrassed in social situations!_w6MlSJmg82A5hPUNlKIc_1_k1nlmyoek6">I could smile with confidence again and never be embarrassed in social
situations!</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;">
<div class="in-r-c"><input id="My teeth or mouth wouldn't hurt me anymore!_w6MlSJmg82A5hPUNlKIc_2_k1nlmyoek6" value="My teeth or mouth wouldn't hurt me anymore!" name="My teeth or mouth wouldn't hurt me anymore!" type="checkbox"
data-required="true"><label style="margin-left:10px;" for="My teeth or mouth wouldn't hurt me anymore!_w6MlSJmg82A5hPUNlKIc_2_k1nlmyoek6">My teeth or mouth wouldn't hurt me anymore!</label></div>
</div><!--]-->
</div>
</div><!----><!---->
</div><!---->
</div>
</div><!--]-->
</div>
</div>
<div class="slide-no-5 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">What has kept you from getting your smile fixed? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Nothing! I'm Ready Right Now!_qSaJQWMK0ligY39GRIq0_0_k1nlmyoek6" value="Nothing! I'm Ready Right Now!" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="Nothing! I'm Ready Right Now!_qSaJQWMK0ligY39GRIq0_0_k1nlmyoek6">Nothing! I'm Ready Right Now!</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Fear of Dental Procedures_qSaJQWMK0ligY39GRIq0_1_k1nlmyoek6" value="Fear of Dental Procedures" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="Fear of Dental Procedures_qSaJQWMK0ligY39GRIq0_1_k1nlmyoek6">Fear of Dental Procedures</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Cost of Dental Procedures_qSaJQWMK0ligY39GRIq0_2_k1nlmyoek6" value="Cost of Dental Procedures" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="Cost of Dental Procedures_qSaJQWMK0ligY39GRIq0_2_k1nlmyoek6">Cost of Dental Procedures</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Time Involved in Dental Procedures_qSaJQWMK0ligY39GRIq0_3_k1nlmyoek6" value="Time Involved in Dental Procedures" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="Time Involved in Dental Procedures_qSaJQWMK0ligY39GRIq0_3_k1nlmyoek6">Time Involved in Dental Procedures</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I Haven't Found A Dentist I'm Comfortable With Yet_qSaJQWMK0ligY39GRIq0_4_k1nlmyoek6" value="I Haven't Found A Dentist I'm Comfortable With Yet"
type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;" for="I Haven't Found A Dentist I'm Comfortable With Yet_qSaJQWMK0ligY39GRIq0_4_k1nlmyoek6">I Haven't Found A Dentist I'm Comfortable With
Yet</label></div>
</div><!--]-->
</div>
</div><!----><!----><!---->
</div><!---->
</div>
</div><!--]-->
</div>
</div>
<div class="slide-no-6 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">Do you understand that Medicare and Medicaid do NOT cover dental implants, and most insurances also do NOT
provide coverage for dental implants? <!----></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Yes_FDz3ON6s4uBZRd38biCP_0_k1nlmyoek6" value="Yes" type="radio"
data-q="do_you_understand_that_medicare_and_medicaid_do_not_cover_dental_implants,_and_most_insurances_also_do_not_provide_coverage_for_dental_implants?" data-required="false"><label style="margin-left:10px;margin-bottom:0;"
for="Yes_FDz3ON6s4uBZRd38biCP_0_k1nlmyoek6">Yes</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="No_FDz3ON6s4uBZRd38biCP_1_k1nlmyoek6" value="No" type="radio"
data-q="do_you_understand_that_medicare_and_medicaid_do_not_cover_dental_implants,_and_most_insurances_also_do_not_provide_coverage_for_dental_implants?" data-required="false"><label style="margin-left:10px;margin-bottom:0;"
for="No_FDz3ON6s4uBZRd38biCP_1_k1nlmyoek6">No</label></div>
</div><!--]-->
</div>
</div><!----><!----><!---->
</div><!---->
</div>
</div><!--]-->
</div>
</div>
<div class="slide-no-7 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">However, many affordable payment plan options exist as little as $65/mo for a single implant or $260/mo for a
full set of upper or lower teeth. Are you interested in a payment plan option? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Yes. I'm Interested In Affordable Payment Plan Options_aQNc4tIN4GMQPaVs0pAc_0_k1nlmyoek6" value="Yes. I'm Interested In Affordable Payment Plan Options"
type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;" for="Yes. I'm Interested In Affordable Payment Plan Options_aQNc4tIN4GMQPaVs0pAc_0_k1nlmyoek6">Yes. I'm Interested In Affordable Payment Plan
Options</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="No, I Will Not Need A Payment Plan_aQNc4tIN4GMQPaVs0pAc_1_k1nlmyoek6" value="No, I Will Not Need A Payment Plan" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="No, I Will Not Need A Payment Plan_aQNc4tIN4GMQPaVs0pAc_1_k1nlmyoek6">No, I Will Not Need A Payment Plan</label></div>
</div><!--]-->
</div>
</div><!----><!----><!---->
</div><!---->
</div>
</div><!--]-->
</div>
</div>
<div class="slide-no-8 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">Payment plans are available based upon credit approval of the patient or a co-signer. Which best describes your
credit? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="500 or less_F08uQeedc81JMnpdr3wU_0_k1nlmyoek6" value="500 or less" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="500 or less_F08uQeedc81JMnpdr3wU_0_k1nlmyoek6">500 or less</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="500-599_F08uQeedc81JMnpdr3wU_1_k1nlmyoek6" value="500-599" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="500-599_F08uQeedc81JMnpdr3wU_1_k1nlmyoek6">500-599</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="600-699_F08uQeedc81JMnpdr3wU_2_k1nlmyoek6" value="600-699" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="600-699_F08uQeedc81JMnpdr3wU_2_k1nlmyoek6">600-699</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="700+_F08uQeedc81JMnpdr3wU_3_k1nlmyoek6" value="700+" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="700+_F08uQeedc81JMnpdr3wU_3_k1nlmyoek6">700+</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I don't know_F08uQeedc81JMnpdr3wU_4_k1nlmyoek6" value="I don't know" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="I don't know_F08uQeedc81JMnpdr3wU_4_k1nlmyoek6">I don't know</label></div>
</div><!--]-->
</div>
</div><!----><!----><!---->
</div><!---->
</div>
</div><!--]-->
</div>
</div>
<div class="slide-no-9 form-builder--wrap-questions ghl-question" data-v-d9fad203="">
<div class="fields-container row" data-v-d9fad203=""><!--[-->
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-even form-field-container" data-v-d9fad203=""><!----><!----><!----></div>
</div>
<div class="col-12 form-field-wrapper" style="margin-bottom:16px;" data-v-d9fad203="">
<div class="f-odd form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">Do you have someone with good credit history who would co-sign with you? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Yes_vrEFvfZNCOoVypjP7YZA_0_k1nlmyoek6" value="Yes" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="Yes_vrEFvfZNCOoVypjP7YZA_0_k1nlmyoek6">Yes</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="No_vrEFvfZNCOoVypjP7YZA_1_k1nlmyoek6" value="No" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="No_vrEFvfZNCOoVypjP7YZA_1_k1nlmyoek6">No</label></div>
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way to pay for a Dental Implant procedure? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Savings_BiU0btaTy22dAqhybUq3_0_k1nlmyoek6" value="Savings" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
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<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Credit Card_BiU0btaTy22dAqhybUq3_1_k1nlmyoek6" value="Credit Card" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="Credit Card_BiU0btaTy22dAqhybUq3_1_k1nlmyoek6">Credit Card</label></div>
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<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Retirement Account_BiU0btaTy22dAqhybUq3_2_k1nlmyoek6" value="Retirement Account" type="radio" data-required="true"><label
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<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Other Loan (Home Equity, etc)_BiU0btaTy22dAqhybUq3_3_k1nlmyoek6" value="Other Loan (Home Equity, etc)" type="radio" data-required="true"><label
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<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Help From A Relative_BiU0btaTy22dAqhybUq3_4_k1nlmyoek6" value="Help From A Relative" type="radio" data-required="true"><label
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<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="No, I Don't_BiU0btaTy22dAqhybUq3_5_k1nlmyoek6" value="No, I Don't" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
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<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">What is your estimated household income (before taxes)? <span>*</span></label>
<div class="flex-col">
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<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="Under $12,000_HU4w34FA49O0ozUOI5BK_0_k1nlmyoek6" value="Under $12,000" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
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<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="$12,000 - $23,999_HU4w34FA49O0ozUOI5BK_1_k1nlmyoek6" value="$12,000 - $23,999" type="radio" data-required="true"><label
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</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="$24,000 - $35,999_HU4w34FA49O0ozUOI5BK_2_k1nlmyoek6" value="$24,000 - $35,999" type="radio" data-required="true"><label
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</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="$36,000 - $49,999_HU4w34FA49O0ozUOI5BK_3_k1nlmyoek6" value="$36,000 - $49,999" type="radio" data-required="true"><label
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</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="$50,000 - $69,999_HU4w34FA49O0ozUOI5BK_4_k1nlmyoek6" value="$50,000 - $69,999" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="$50,000 - $69,999_HU4w34FA49O0ozUOI5BK_4_k1nlmyoek6">$50,000 - $69,999</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="$70,000 - $94,999_HU4w34FA49O0ozUOI5BK_5_k1nlmyoek6" value="$70,000 - $94,999" type="radio" data-required="true"><label
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</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="$95,000 +_HU4w34FA49O0ozUOI5BK_6_k1nlmyoek6" value="$95,000 +" type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="$95,000 +_HU4w34FA49O0ozUOI5BK_6_k1nlmyoek6">$95,000 +</label></div>
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<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">Do you feel like you are ready to do something about your situation? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="No, I'm Fine Without Doing Anything_FQ0VEH9vawQgbMlCR0qN_0_k1nlmyoek6" value="No, I'm Fine Without Doing Anything" type="radio"
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</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I'm Interested, But Don't Feel Ready Yet_FQ0VEH9vawQgbMlCR0qN_1_k1nlmyoek6" value="I'm Interested, But Don't Feel Ready Yet" type="radio"
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</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I'm Ready To Do Something, But Want To Explore My Options_FQ0VEH9vawQgbMlCR0qN_2_k1nlmyoek6"
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</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I Need To Do Something Fast!_FQ0VEH9vawQgbMlCR0qN_3_k1nlmyoek6" value="I Need To Do Something Fast!" type="radio" data-required="true"><label
style="margin-left:10px;margin-bottom:0;" for="I Need To Do Something Fast!_FQ0VEH9vawQgbMlCR0qN_3_k1nlmyoek6">I Need To Do Something Fast!</label></div>
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<div id="form-full_name" class="form-builder--item-input form-builder--item"><!----><label class="label-alignment">Enter your name and hit the enter key. <span>*</span></label>
<div class="flex-col"><input type="text" placeholder="Name" name="full_name" class="form-control" id="full_name" data-required="true"><!----></div><!----><!---->
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<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item field-container form-builder--item-input" data-v-d9fad203=""><label class="item-description" style="display:block;">
<h6><em><span style="color: #808080;">We may contact you to provide information and offer a consultation.</span></em></h6>
</label><label class="label-alignment">Enter your best email and hit the "Enter" key <span>*</span></label>
<div class="flex-col">
<div class="flex email-input"><input placeholder="Email" name="email" type="email" class="form-control" data-required="true"><!----></div><!----><!----><!---->
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<div id="form-phone" class="form-builder--item-input form-builder--item"><label class="item-description">
<h6><em><span style="color: #808080;">We may contact you to provide information and offer a consultation.</span></em></h6>
</label><label class="label-alignment">Enter your best phone number and hit the "Enter" key. <span>*</span></label>
<div class="flex-col">
<div class="flex phone-input" style=""><input type="tel" name="phone" placeholder="Phone" autocomplete="off" class="countryphone" id="phone" data-required="true"><!----></div><!----><!----><!---->
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<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment">Which of the following best describes you? <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="This is the first time I am exploring dental implants._D16g22m6fZdQgwlyOcI7_0_k1nlmyoek6" value="This is the first time I am exploring dental implants."
type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;" for="This is the first time I am exploring dental implants._D16g22m6fZdQgwlyOcI7_0_k1nlmyoek6">This is the first time I am exploring dental
implants.</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I have researched dental implants before but never gone to a consultation._D16g22m6fZdQgwlyOcI7_1_k1nlmyoek6"
value="I have researched dental implants before but never gone to a consultation." type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="I have researched dental implants before but never gone to a consultation._D16g22m6fZdQgwlyOcI7_1_k1nlmyoek6">I have researched dental implants before but never gone to a consultation.</label></div>
</div>
<div style="position:relative;display:inline-block;width:100%;" class="option-radio">
<div style="display:flex;align-items:baseline;margin-bottom:5px;"><input id="I have been to a consultation before and am looking for a second opinion._D16g22m6fZdQgwlyOcI7_2_k1nlmyoek6"
value="I have been to a consultation before and am looking for a second opinion." type="radio" data-required="true"><label style="margin-left:10px;margin-bottom:0;"
for="I have been to a consultation before and am looking for a second opinion._D16g22m6fZdQgwlyOcI7_2_k1nlmyoek6">I have been to a consultation before and am looking for a second opinion.</label></div>
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<div class="f-even form-field-container" data-v-d9fad203=""><!---->
<div class="form-builder--item form-builder--item-input" data-v-d9fad203=""><!----><label class="field-label label-alignment"> <span>*</span></label>
<div class="flex-col">
<div style="width:100%;"><!--[-->
<div style="position:relative;display:inline-block;width:100%;">
<div class="in-r-c"><input id="I give my permission to be contacted via call, email, and/or text message regarding my dental health._mgly8WtRh0GXZbOumEst_0_k1nlmyoek6"
value="I give my permission to be contacted via call, email, and/or text message regarding my dental health." name="I give my permission to be contacted via call, email, and/or text message regarding my dental health."
type="checkbox" data-required="true"><label style="margin-left:10px;" for="I give my permission to be contacted via call, email, and/or text message regarding my dental health._mgly8WtRh0GXZbOumEst_0_k1nlmyoek6">I give my
permission to be contacted via call, email, and/or text message regarding my dental health.</label></div>
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</form>Text Content
(318) 889-3434 2015 E 70 th St, shreveport LA 71105 (318) 889-3434 2015 E 70 th St, shreveport LA 71105 Watch: This video will explain all of your options for Dental Implants. Next Step: Now that you know your options, find out if you are eligible for dental implant treatment and general pricing by completing the short evaluation below: What condition best describes you? * 1 Tooth Is Missing or Needs Pulled Multiple Teeth Are Missing or Need Pulled I'm Struggling With Traditional Dentures Most of My Teeth are In Pretty Bad Condition Do you currently have any of these dental solutions? * Denture or Partial Denture Bridge/ Crown Dental Implant None of the Above 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 What would be the biggest life change that we could help you experience by fixing this problem? (Check all that apply.) * I could eat the foods I want to again! I could smile with confidence again and never be embarrassed in social situations! My teeth or mouth wouldn't hurt me anymore! What has kept you from getting your smile fixed? * Nothing! I'm Ready Right Now! Fear of Dental Procedures Cost of Dental Procedures Time Involved in Dental Procedures I Haven't Found A Dentist I'm Comfortable With Yet Do you understand that Medicare and Medicaid do NOT cover dental implants, and most insurances also do NOT provide coverage for dental implants? Yes No However, many affordable payment plan options exist as little as $65/mo for a single implant or $260/mo for a full set of upper or lower teeth. Are you interested in a payment plan option? * Yes. I'm Interested In Affordable Payment Plan Options No, I Will Not Need A Payment Plan Payment plans are available based upon credit approval of the patient or a co-signer. Which best describes your credit? * 500 or less 500-599 600-699 700+ I don't know Do you have someone with good credit history who would co-sign with you? * 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? * Savings Credit Card Retirement Account Other Loan (Home Equity, etc) Help From A Relative No, I Don't What is your estimated household income (before taxes)? * Under $12,000 $12,000 - $23,999 $24,000 - $35,999 $36,000 - $49,999 $50,000 - $69,999 $70,000 - $94,999 $95,000 + Do you feel like you are ready to do something about your situation? * No, I'm Fine Without Doing Anything I'm Interested, But Don't Feel Ready Yet I'm Ready To Do Something, But Want To Explore My Options I Need To Do Something Fast! Enter your name and hit the enter key. * WE MAY CONTACT YOU TO PROVIDE INFORMATION AND OFFER A CONSULTATION. Enter your best email and hit the "Enter" key * WE MAY CONTACT YOU TO PROVIDE INFORMATION AND OFFER A CONSULTATION. Enter your best phone number and hit the "Enter" key. * Which of the following best describes you? * This is the first time I am exploring dental implants. I have researched dental implants before but never gone to a consultation. I have been to a consultation before and am looking for a second opinion. * I give my permission to be contacted via call, email, and/or text message regarding my dental health. NEXT Smile Transformations You Deserve To Smile Again! Your oral health problems affect your day to day life in ways that many people with healthy teeth take for granted. From struggling to eat the foods you want, the anxiety and embarrassment that drives you to avoid social situations, and maybe even having to deal with chronic pain on a daily basis - living with a damaged smile can be downright debilitating. We hear stories every day of the physical and emotional pain caused by failing oral health, but we also get the joy of seeing peoples’ lives changed by the miracle of dental implants. It is our greatest pleasure to witness a patient come out of treatment and greet the world with not only a transformed smile, but also a transformed life! How would dental implants change YOUR life? Complete Evaluation Takes approximately 90 seconds. Understand Your Tooth Replacement Options Single Implant If you have a single missing tooth, a single implant is the best option as it is a lifelong solution that can replace any missing tooth without having to harm the teeth on either side. Implant Secured Bridge If you are missing several teeth in a row, an implant secured bridge is likely your best option as you can bridge the gap in your smile with just one implant on either side. Implant Secured Denture The implant secured denture, also known as an over-denture, is the best option for the average middle class person who wants the benefits of implants (such as stability of bite and saving the jaw bone structure) but also wants something more affordable than a full fixed arch. Full Fixed Arch The full fixed arch is the best option when it comes to replacing missing teeth. A custom-made arch creates the perfect, gorgeous smile you've always dreamed of, and is secured by 4-8 implants per arch. A full fixed arch looks and functions just like natural teeth and allows you to achieve a Hollywood ready smile! Complete Evaluation Takes approximately 90 seconds. Meet Our Implant Specialist, Dr. Mario Pary, DMD Growing up, Mario Pary wasn’t a big fan of going to the dentist – in fact, he planned to follow in his father’s footsteps as a physician. It wasn’t until a college volunteer program with a community dental clinic that he discovered his calling for dentistry. After completing his undergraduate degree in biology at the University of California at Irvine (just 10 minutes from where he grew up), he was then accepted to the Temple School of Dentistry in Philadelphia. There, he met his wife, and the two relocated to Louisiana after he graduated from dental school.His professional affiliations and memberships include the American Academy of Implant Dentistry, and Fellowship Status with the Academy of General Dentistry. Dr. Mario Pary is a bilingual general dentist, providing comprehensive oral health services to English and Spanish speaking patients of all ages. A COMMITMENT TO CONTINUED LEARNING Each year Dr. Mario Pary completes hundreds of hours in continuing education, in services like implants, aesthetics, full mouth reconstruction, smile makeovers, and endodontics. In fact, one of his orthodontic training courses consisted of over 140 hours of training time! OUT OF THE OFFICE When he isn’t spending time with his wife or their two beautiful daughters, Dr. Pary thoroughly enjoys restoring classic VB Beetles and playing the guitar – but please, don’t ask him to serenade you during your visit! The Premier Dental Implant Specialists of Shreveport! Complete the Evaluation: complete the evaluation to find out if dental implants are right for you, general pricing options, and what options are best for you. Complete Evaluation Takes approximately 90 seconds. Privacy Policy Contact Us