LES Dental Group

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Section 1 Title

How many teeth are you missing in total? *

Most insurance companies only cover a small portion of dental implant treatment. However, we can help you make the most of your insurance benefits. If you need to pay out-of-pocket, have you planned how you will pay? *

Perfect. Is this something you've been saving up for? *

If you are looking to finance your dental treatment, healthcare financing companies will ask for a source of income. Do you have a job / source of income? *

Section 2

If you require financing, please select the option below that best describes your credit history.

Should you have difficulty getting approved for financing, do you have a co-signer with at least a 660 credit score that can help you? *

What is your relationship to your co-signer? *

Will your co-signer be able to come to the consultation appointment with you or be available by phone for 10 to 20 minutes if they cannot attend the consultation appointment? *

Section 5

Dental implant treatment can start at $3,500 for a single tooth and $25,000 for a whole arch of teeth. Is that an investment your co-signer will be open to cosigning with you? *

Although we have a special offer for the first appointment, we do expect new patients to respect our time and show up for their appointment. Do you commit to showing up for your appointment at the time it is scheduled? *

When is the best time to contact you? *

Section 7 Title

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