Survey - Premier Dentistry

How Would You Like to Book Your Appointment?

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Do You Have Dental Insurance?

PPO Plan

HMO Plan

Medicaid

Medicare (Senior Citizen Insurance)

No Insurance

What Dental Treatment Are You Looking For ?

Braces
Broken Teeth
Cavity
Crown
Dental Implants
Dentures
Extraction
Root Canal
Toothache
Teeth Cleaning

How soon would like to visit the dentist?

As soon
as possible

Within
1 week

Within
2 week

In more then
2 weeks

How do you feel about visiting the dentist?

If needed, we have dentists trained specifically in dental anxiety.

Not at all

nervous

A little

nervous

Moderately

nervous

Very

nervous

Extremely

nervous

Do You Have Dental Insurance?

PPO Plan

HMO Plan

Medicaid

Medicare (Senior Citizen Insurance)

No Insurance

We Are Not In Network With Your Insurance. But, we have a great offer for you! Exam, X-Ray & Cleaning for $149. We have very flexible payment plan options as well, Please CALL (503) 751-3520 Now!

Are you ready to book now?

Yes

I'm ready

No

I'm not ready

What is your contact info?

Enable secure booking by providing your contact info. We respect your privacy and time.