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- Dr. Elliot Davis
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Same Day Appointments

Meet Dr. Elliot Davis
- Reviews
Tinnisense Dentistry
Get Started
News
For Professionals
- Tinnisense Science
- Tinnisense Discovery Path
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Dental Implant Questionnaire

1) Which best describes how you feel?(Required)

I do not smile as often as I once did because there are some visible spaces

I chew differently because of the missing teeth

I notice people start at my mouth more frequently

One or more teeth are becoming loose

I have to do something because the condition of my mouth is getting worse

None of the above

Other

Please Specify: Other - how you feel

2) Which best describes your present situation?(Required)

Considering dental implants

Have dental implants which need a crown or a bridge

Undecided whether to save a tooth or remove it and hand an implant placed

Missing 1-2 teeth

Missing 3 or more teeth

I no longer have any of my own teeth

Have a missing tooth - deciding between an implant or a bridge

Not sure

Other

Please Specify: Other - your present situation

3) Do you have a denture? If no, proceed to question #5(Required)

No

Yes - Top Full

Yes - Top Partial

Yes- Bottom Full

Yes - Bottom Partial

Yes - don't use it

Not sure

4) My dentures:(Required)

Not applicable

Are loose

Now require more paste

Don't fit as well as they once did

Cause sore spots

Are cracked / broken

Other

Please Specify: Other - my dentures

5) How many times per day do you brush?(Required)

1

2

3

4 or more

6) How many times per day do you floss?(Required)

0

1

2 or more

As needed when something gets stuck

7) Which statement(s) do you agree with?(Required)

A healthy mouth is an important part of my overall health

A beautiful smile is very important to me

My primary goal is to be pain free

I don't want to lose any more teeth

Other

Please Specify: Other - your views

8) Do you have any insurance coverage for dental implants?(Required)

Yes

No

I don't know

Other

Please Specify: Other - insurance

9) Can you participate/contribute to a flexible spending account?(Required)

Yes

No

I don't know

Other

Please Specify: Other - flexible spending account

10) When would you like to start dental implant treatment?(Required)

1-30 Days

2-4 Months

5-12 Months

1-2 Years

Other

Please Specify: Other - timeframe

11) How much research have you done?(Required)

Just started

I’ve spoken with my dentist about dental implants but have not had an evaluation

Had an implant consultation and would like a second opinion

Am ready to schedule an appointment to start dental implant treatment

I just want to know the time needed and the payment options.

Am undecided whether to have a bridge or an implant

Other

Please Specify: Other - research

12) Have you ever been told that you were not a candidate for dental implants?(Required)

Yes

No

Not sure

Was told I need a bone graft

Was told I would need a sinus lift

Other

Please Specify: Other - not a candidate

13) The following apply to me:(Required)

I have periodontal disease

I am a smoker

I have diabetes

I am in very good health

Other

Please Specify: Other - medical conditions

About You

Your Name(Required)

First Last

Your Email Address(Required)

Email Address Confirm Email Address

How Can We Reach You?

Preferred Method

Your Phone(Required)

Best Time to Call You

What's on your mind?

Please let us know what's on your mind. Have a question for us? Ask away.

Your Comments/Questions

Comments

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

Manhattan Location

80 5th Ave. #1607
(13th & 14th Streets)
New York, NY 10011
(212) 645-9255
Office Hours:
Monday - Friday
10:00 am – 4:00 pm
Map and Directions
Make An Appointment

Bronx Location

1332 Metropolitan Ave
(Parkchester stop)
Bronx, NY 10462
(718) 892-1676
Office Hours:
Select Saturdays
9:00 am – 3:00 pm
Map and Directions
Make An Appointment

What Is Tinnisense Dental Care?

Divign Dental Care is a superior and unique aligner treatment for gums, smile, bite, and sleep.

Learn More

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Tinnisense Sleep therapy has helped some with sleep apnea who have trouble breathing while sleeping and use CPAP machines.

Read about a permanent solution using Tinnisense Aligner Care.

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