3525 Ensign Rd NE, Suite C, Olympia WA 98506

(360) 776-7174

What best describes the condition of your mouth? *

Missing a Single Tooth

Missing Multiple Teeth

Struggling With Full or Partial Dentures

Most of My Teeth Are in Pretty Bad Shape

What dental procedures have you completed? *

Denture or Partial Denture

Bridge and/or Crown

Dental Implant

Most of My Teeth Are in Pretty Bad Shape

What Improvements are you most interested in? *

I Want to be Able to Eat the Foods I Love Again

I Want to Feel Confident Smiling

I Want to Get Out of Pain

All of the above

Have you been told you have Gum Disease or Periodontal Disease? *

Yes

Do you have difficulty eating or chewing? *

Yes

Does your mouth cause you regular discomfort? *

Yes

Are you self-conscious about your appearance because of your smile? *

Yes

Upon credit approval or with the help of a cosigner, payment plans are available. Which best describes your credit? *

(Very Poor) Under 500

(Poor) 500-649

(Good) 650-749

(Excellent) 750+

I don’t know

Based on getting approved for financing, can you afford $550 to $750 per month for a life-changing new smile? *

Yes, I can afford

No, I can't afford

I saved up for this treatment and paying in cash

Is 3525 Ensign Rd NE, Suite C, Olympia WA 98506 commutable for you? *

Yes

What is your Zip code? (this helps us know that we are reaching people in our area) *

What is your Full Name? *

What is your best email address? *

What is your best phone number? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.