Please answer these questions:

How many teeth are you currently missing? *

All

6+

4-5

3 Or Less

How ready do you feel to do something about your situation? *

Somewhat Ready

Very Ready

I Need Something FAST!

How are you planning to handle the investment? *

Paying cash / out of pocket

Interested in monthly financing options

Part cash, part financing

Not sure yet

Roughly where does your credit sit?

Excellent, about 720 or higher

Good, about 660 to 719

Fair, about 600 to 659

Below 600, or rebuilding

I honestly do not know

If you needed a co-signer, do you have one?

Yes, I have someone

Maybe, I would need to ask

No, it would just be me

I will not need one

When is the best time to call you back?

Morning: 8 AM – 11 AM

Afternoon: 11 AM – 2 PM

Evening: 2 PM – 5 PM

What is Your Name *

Email

Phone *

By checking this box, you agree to receive text messages from Roots Dental regarding appointments, reminders, special offers, promotions, and updates. Message frequency may vary. Message and data rates may apply. Reply STOP to opt out or HELP for assistance.

Privacy Policy | Terms of Service

NEXT