All-On-X Dental Implants - Pre-Consult Survey

Patient Name

Date of Birth

1.⁠ ⁠What are your main goals for improving your smile or oral health? 1.⁠ ⁠What are your main goals for improving your smile or oral health? Restore missing or broken teeth Improve comfort or reduce pain Enhance confidence and appearance Other

Other:

2.⁠ ⁠Which treatment option are you most interested in learning about? 2.⁠ ⁠Which treatment option are you most interested in learning about? Fixed Full-Mouth Solution ($25,000 - $32,000 per jaw) Non-Fixed Full-Mouth Solution ($8,000 - $15,000 per jaw) Unsure – would like to discuss options

3.⁠ ⁠How do you plan to fund your treatment? 3.⁠ ⁠How do you plan to fund your treatment? Using Superannuation (own or partners) Payment plan / other finance option Not sure yet – would like more information.

4.⁠ ⁠How would you describe your current dental situation? 4.⁠ ⁠How would you describe your current dental situation? Missing or broken teeth Ongoing pain or sensitivity Difficulty chewing or smiling confidently Fear or anxiety about dental visits Other

Other: