SERVING THE SAN DIEGO METRO AREA

Why Trusmile
About us
Dental Implants
Patient Resources
Referring Doctors
Contact us

Why Trusmile
About us
Dental Implants
Patient Resources
Referring Doctors
Contact us

LEADERS IN FULL-MOUTH DENTAL IMPLANTS

Why Trusmile
About us
Dental Implants
Patient Resources
Referring Doctors
Contact us

Why Trusmile
About us
Dental Implants
Patient Resources
Referring Doctors
Contact us

Questionnaire

Need Help? We’re Here for You

Complete this quick form and we’ll follow up with you

"*" indicates required fields

How Many Missing Or Broken Teeth Do You Have?*

All

4 Or More

3 Or Less

Have You Been Diagnosed With Periodontal Disease or Have Several Loose Teeth?*

Yes

Select the option below that best fits your situation*

I want to replace ALL my teeth with new permanent teeth

I want to replace my upper or lower set of teeth

I only want to have a couple teeth replaced

I don't want any of my teeth replaced

What Is Your Age?*

55 and older

40-54

Under 40

Do you currently have any of these dental treatments?*

Dentures

Crowns and/or Bridges

Dental Implant

None of the above

How Long Have You Been Missing Your Teeth?*

I Still Have Them

1-4 Months

4-12 Months

1 or more Years

Do you Have To Modify The Way You Chew or Are You Currently Unable To Eat Certain Foods?*

Yes

Are You Currently Trying To Find Relief From Any Kind Of Pain Or Discomfort?*

Yes

Are You Embarrassed Or Hiding Your Smile?*

Yes

Have You Had A Dental Implant Consultation With Another Dentist?*

Yes

How Ready Are You To Do Something About Your Situation?*

I am ready NOW!

Very ready

Not sure I am ready

Dental Implant procedures are not covered by insurance. However, many affordable payment plans are available. Are you interested in a payment plan option?*

Yes. I'm interested in affordable payment plan options

No. I've been saving for this type of procedure and will not need a payment plan

Dental Implant procedures are not covered by insurance. Our full arch implants begin around $17,500. We have payment plans averaging $300/mo. Would you like to see if you qualify for a payment plan, or continue without?*

Yes, please tell me if I might qualify for a payment plan

No. I've been saving for this type of procedure and will not need a payment plan

Do you live near San Diego, CA?*

Yes

What region of the country do you live in?*

Northeast Region

Midwest Region

West Region

Southeast Region

Southwest Region

None of the above

What Is Your First Name?*

What Is Your Last Name?*

What Is Your Zip Code?*

Please enter a number from 1000 to 99999.

What Is Your Email?*

What Is Your Phone Number?*

Name

This field is for validation purposes and should be left unchanged.

Hours

Monday: 9am – 5pm
Tuesday: 9am – 5pm
Wednesday: 9am – 5pm
Thursday: 9am – 5pm
Friday: 9am – 5pm
Saturday: Closed
Sunday: Closed

Contact

2452 Fenton St #100,
Chula Vista, CA 91914

(619) 485-9991
info@trusmileimplants.com

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