Dental Practice

1. How many teeth are you missing?

1 tooth 2-3 teeth 4-6 teeth More than 6 teeth

2. Does Your Condition Have A Negative Impact On Your Ability To Eat or Chew Certain Foods?

Yes No

3. Are you currently wearing dentures or partials?

Yes No

4. How long have you been wearing dentures or partials?

1-3 years 4-7 years More than 7 years

5. Do you smoke or use nicotine in any form?

Yes No

6. Do you suffer from any heart or lung disease/condition?

Yes No

7. Are you diabetic?

Yes, A1c over 7% Yes, A1c under 7% No

8. Do you suffer from any autoimmune disease?

Yes No

Dental Implant Candidacy Quiz