Do you experience frequent tooth pain or sensitivity?
Yes, almost every day
Occasionally
No, not at all
Have you lost one or more teeth due to decay, injury, or gum disease?
Yes, multiple teeth
Just one or two
No, all my teeth are intact
Do you find it difficult to chew certain foods (like meat or crunchy vegetables)?
Yes, chewing is painful or difficult
Sometimes, depending on the food
No, I eat comfortably
Are you unhappy with the appearance of your smile due to missing or damaged teeth?
Yes, it affects my confidence
A little, but not a major concern
No, I'm happy with my smile
Has your dentist recommended dentures or tooth replacement options?
Yes, they have
They mentioned it as an option
No, never discussed it
Are you interested in same-day dentures?
Yes
No
Are you interested in dental implants?
Yes
No
I would like to know more how implants can help me.
How soon do you want to get started?
1-2 days
3-4 days
Over a week
Is there anything else you'd like to share about your dental needs or concerns?
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