Are you a Candidate for Dental Implants?

Our practice is located in Carmel, IN. Are you able and willing to travel to this location for treatment? *

Yes

Do you currently have any of the following? (Select all that apply): *

Crowns or bridges

Partials

Full removable dentures

None of the above

Which of the following best describes your current dental situation? *

I still have all of my natural teeth

I'm missing one tooth

I'm missing several teeth

I'm missing all of my teeth

Is your current condition making it difficult to eat or chew certain foods? *

Yes

What’s most important to you when it comes to treatment? *

Function- being able to eat, chew and speak comfortably

Aesthetics- having a natural, beautiful smile

Both

Dental implants are rarely covered by insurance, but we offer affordable payment plans. Would you be interested in exploring those options? *

Yes, I’m interested in payment plans

No, I plan to pay in full

If yes, what’s your estimated credit score range? *

Under 600

600-650

650-700

700+

What would be a comfortable monthly payment range for you? *

I’m not interested in financing

$100–$200/Month

$200–$300/Month

$300–$350/Month

$350+/Month

What has been the biggest reason for delaying treatment? *

Cost

Time

Fear or anxiety about the procedure

Haven't found the right dental team

Ready to schedule your consultation with SmileCentric?

Providing the information below allows us to put you in our patient system for scheduling purposes.

This is in no way a commitment to a treatment plan.

First Name *

Last Name *

Phone *

I'd Like to Receive Text Messages Regarding my Dental Implant Journey

Yes

Email *

Address

City

State

Postal code

Thanks for your interest in dental implants at SmileCentric. Right now, we only offer treatment at our Carmel, Indiana office.