General Lead Questionnaire

What is your main concern with regards to your oral health? Select al that apply.

I think I have cavities

I have broken and/or missing teeth and will need dentures or implants

I have persistent bad breath and my gums sometimes bleed when I brush

I had a root canal but never got a crown

I have one or more defective crowns that need to be replaced

I am in pain

I have swelling on my gum that is recurrent

I need to correct one or more of the following issues: gaps, crowding, overbite, or underbite.

No dental issues, just overdue for my cleaning

When was the last time you had a complete exam done by a dentist?

Without insurance and a credit score below 620, you may not be approved for financing; however we have in-house payment plans. Here is what to expect: Your initial consultation is free but the xrays will cost $152. Based on your selections, we estimate that your treatment will require a down payment of several hundred dollars to one thousand dollars or more. The actual diagnosis and cost of your treatment will deternind after the consultation. Which of the following options best describes your financial situation?

I have no money to put down for dental treatment at this time

If find the right doctor, I will be able to start treatment with a down payment of no more than $500

If find the right doctor, I will be able to start treatment with a down payment of no more than $1000

If find the right doctor, I will be able to start treatment with a down payment of $1000 or more

If find the right doctor, I will most likely pay outright for my treatment

Valid for new patients who complete a cleaning and/or any other dental treatment

8500 Annapolis Rd New Carrollton, MD 20784
Tel: 240-487-6119

FREE TEETH WHITENING

Dr. Lynn and Team

After filling out the form below, you will be
redirected to our online scheduling page where you can make an appointment on our live schedule

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Dentist Near Me New Carrollton, MD

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