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Dental Implant Consultation Assessment

Answer a few quick questions so we can match you with the best local provider

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National Implant Network

We organize your implant consultation and connect you with an appropriate licensed provider.

This takes about 2–3 minutes.

🔒 Secure intake • Used only to coordinate your consultation • No spam

Your ZIP Code (Used to match you with licensed providers in your area)

Name *

Email: (Your email is only used to coordinate your consultation) *

Best Phone Number *

Select...

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Text Message Consent (Optional)

I agree to receive text messages from National Implant Network related to my inquiry. Message frequency varies. Message & data rates may apply. Reply STOP to opt out or HELP for assistance. Consent is not a condition of purchase.

When do you want to start moving forward? (This doesn’t commit you to treatment) *

Yes — I’m ready to schedule a consultation

I’m researching options

Not sure yet

What are you primarily looking for help with? *

Replacing a single missing tooth

Replacing multiple missing teeth

Securing loose or uncomfortable dentures

I’m not sure yet / need guidance

Approximately how many teeth are involved? *

1 tooth

2–3 teeth

4–8 teeth

Most or all teeth

Not sure

Which area needs treatment? *

Upper teeth

Lower teeth

Both

Not sure

financing_openness

Open to monthly payments / financing

Paying out of pocket

Insurance

Not sure yet

Have you already had a consultation?

Yes

Anything you’d like the provider to know before the consultation?

By submitting this form, you agree to our Privacy Policy and Terms of Service.

✅ Licensed implant providers

✅ No sales call centers

✅ Matched based on your case

YOUR EXCLUSIVE MATCHING PROCESS

How We Connect You with the Right Provider

We hand-match you with one primary provider who specializes in your specific needs—no spam, no overwhelming options, just personalized attention.

Personalized Review of Your Case

Our team personally evaluates your goals, location, and treatment preferences to identify the single best-matched provider for your situation.

Direct Introduction to Your Matched Provider

We facilitate a direct introduction to one carefully selected provider in your area who will reach out to discuss consultation details.

You Control the Conversation

No pressure, no obligation. You decide how to proceed—ask questions, discuss options, or schedule when you're ready.

🔒 Exclusive Provider Match ✉️ No Spam or Lists 🛡️ Secure & Confidential Intake

Important Information

National Implant Network provides educational information and intake coordination only and does not provide medical advice, diagnoses, or treatment recommendations. Any clinical decisions are made solely between you and your licensed provider. By submitting this form, you authorize us to share your information with one matched provider for follow-up. You also consent to receive service-related calls, texts, and emails; message frequency varies; message & data rates may apply; reply STOP to opt out and HELP for assistance. View our Privacy Policy and Terms of Service.

Complete your assessment above and click Start My Implant Consultation

National Implant Network 2541 W Pollo Circle, Flagstaff, AZ 86001 (928) 326-1035 support@nationalimplantnetwork.com Privacy Policy | Terms of Service