Dental Implants, Dentures and FMR-FB

To Book an Appointment for a Free Consultation with Our Expert Implantologist/Dentist

Please provide us the following details

Step 1 of 3

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Name(Required)

Age(Required)

Gender(Required)

Phone(Required)

Email(Required)

City(Required)

Have you visited a dentist before for dental implant treatment?(Required)

Yes

No

How many teeth are missing in your mouth?(Required)

None

Less than 5

More than 5

No teeth

Do you wear a denture?(Required)

Yes

No

How long have you been wearing a denture?(Required)

Yes

No

Have you ever undergone a dental implant surgery before in your life?(Required)

Yes

No

Are you aware that each dental implant may cost approximately Rs.25,000/-?(Required)

Yes

No

Do you have an OPG / Full Mouth X-Ray with you?(Required)

Yes

No

How soon are you planning to get the surgery done?(Required)

Immediately/ASAP

In one month

In 3 months

Not sure

Do suffer from high blood pressure?(Required)

Yes

No

Do you have diabetes?(Required)

Yes

No

Do you have any heart related ailments?(Required)

Yes

No

Do take blood thinners like Aspirin or any other heart medicine?(Required)

Yes

No

Do you smoke or chew tobacco?(Required)

Chew Tobacco

Smoke

Chew Tobacco & Smoke

No to both

When can you come for a checkup with our Implantologist (Dentist with specialisation in dental implants)?(Required)

Yes

No

Would like to talk to a dentist right away?(Required)

Yes

No

Would you like to book an appointment at a Sabka Dentist Clinic?(Required)

Yes

No

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