What is your current dental situation? *

I have most of my teeth, but they are in bad shape

I have a partial denture/complete denture

I have problems with my implant denture

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Are you ready to start your dental treatment? *

I am just looking for information

I would like a second opinion

I am ready to start

Implant treatment can be costly and it is often not covered by insurance. What is your financial availability? *

I can only do it if there is a financing plan available

I have been saving and I am able to afford treatment

Payment plans are available based on credit approval ofthe patient or a co-signer. Which best describes your credit? *

(Poor) under 660

(Fair) 660-699

(Good) 700-739

(Excellent) 740+

Which best describes your current household monthly income? *

Under $5,000

$5,000 to $8,000

Over $8,000

First Name *

Last Name *

Phone *

Email *

How did you hear about Milano Dental Studio? *

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