Dental Implants Questionnaire

Do you have any loose or damaged teeth?

Yes No

Do you have any missing teeth?

Yes No

If yes how many?

How long have you had missing teeth?

Have you had dental implants before?

Yes No

Do you struggle to eat?

Yes No

Do you avoid smiling?

Yes No

Do you have difficulties talking?

Yes No

Do you currently wear dentures?

Yes No

Do you have a dental bridge?

Yes No

How healthy are your existing teeth?

Are you interested in one or more dental implants?

Why do you think dental implants is the right treatment for you?

What type of dental implants are you interested in?

Have you had a dental consultation before about your loose or missing teeth?

Yes No

If so, did you see a dentist or implantologist? And what advice was given?

Would you like to set-up a consultation?

Yes No

If yes what is your preferred date and time?

Your Details

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