EXCLUSIVE TO CHINO HILLS & SURROUNDING AREAS ONLY:

ARE YOU A CANDIDATE FOR DENTAL IMPLANTS?

DENTAL IMPLANT EVAULATION

We are Located In Chino Hills, CA. Are You Willing To Travel To This Location? * *

Yes

No

Do you have any of the following? *

Chipped Teeth

Cracked Tooth

Stains on Teeth

Spaces Between Teeth

Missing Teeth

All of the Above

What Is The Most Important Outcome You Are Seeking? *

Function - Eating, Chewing, Talking

Aesthetics - Beautiful, Natural Looking Teeth

Both Are Equally As Important

What Is your Level of Urgency To Find Relief From Any Type Of Pain Or Discomfort That You May Be Feeling? *

1 - Very Little, I'm Not In A Rush

2- Moderate, I-3 Months

3 - High, I'm Looking For Help Now!

What is the most important factor that has prevented you from getting treatment

Time

Money

Fear

Can't find the right Dentist

Do you currently have any of these dental solutions? *

Dentures or Partial Dentures

Bridge/ Crown

Dental Implant

None of the above

Are You Interested in Learning About Our Easy Monthly Payment Plans? If So, What Dollar Range Would You Like To Pay Monthly * *

No Financing

$50-149/Month

$150-$249/Month

$250-349/Month

Over $350/Month

What is your credit score? *

Under 500

500 - 600

650 - 700

Above 700

Are you prepared to invest in your smile transformation? *

Yes! I am prepared to invest in my smile

No, I am not

First Name *

Last Name *

Phone *

Email *

Postal code *

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

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I understand the information disclosed in this form may be subject to re-disclosure and may no longer be protected by HIPAA privacy regulations and the HITECH Act. I understand that by hitting "Submit" I am opting into receiving text, emails, and phone calls relating to booking a dental implant consultation.

Dr. Kim is Giving Away 14 Implant Consultation Packages FREE ( $679 Value) to Help Those Need!

Included For FREE This Month Only For The First 14 Request!

Free Dental Implant Exam ($179 Value)

Free 3D Xray ($500 Value)

Free Smile Makeover Analysis

Complete Treatment Plan

Free Financing Plan

AFFORDABLE

TEETH IN ONE DAY

We understand your missing teeth contribute to

missing out on the foods you love, social moments, and inhibit the

basic human expression of smiling.

WE CAN HELP YOU.

Talk to Us:

(844) 763-3731

THEY'RE NOT JUST NEW TEETH ...

IT CHANGES YOUR LIFE.

*Real client testimonials

"Dental Implants Not Only Improved My Smile, But My Health Overall"

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