How Many Teeth Are you Missing? *

Missing 1 Tooth

Missing More Than 1 Tooth

Many of My Teeth are Broken or Missing

None of the above

Do You Have Any of These Dental Solutions Now? *

Dental Crowns or Bridges

Dentures or Partial Dentures

Dental Implant or Implants

None of the above

What has prevented you most from fixing your smile? *

Please note that insurance does not fully cover dental implant procedures, but we have several easy and affordable payment plans.

Would you be interested in a payment plan option?

Yes

Please note implant financing and payment plans are available based on the credit approval of the patient or a co-signer. Which score best describes your FICO credit score?

Unfortunately, you may not qualify for our payment plan options based on your current credit score. However, you may have other payment options available not requiring good credit scores. Please choose any or all that apply.

Your current finances may prohibit you from getting dental implants, but we may have other solutions to help. Are you interested in lower-cost alternatives to dental implants?

Yes

If fear is preventing you from fixing your teeth, there's no need to worry! Our dental team is skilled at using oral sedation dentistry techniques to help you feel relaxed and comfortable for a worry-free, painless dental experience. This also helps Dr. Bharathi to achieve higher quality treatment for you in less time.

Would you like to speak with us about oral sedation dentistry and dental implants?

Yes

Rest assured, you are in great hands at Radiance Dental. Dr. Bharathi is a leading provider of dental implants across the United States and will work with you and your budget to restore your smile and confidence again.

Would you like to speak with us about how we can help you fix your teeth with dental implants?

Yes

The first step to finally fixing your teeth is to schedule a free, no-pressure consultation with Dr. Bharathi ASAP. We will answer all your questions during this exam and determine if dental implants are right for you or perhaps another treatment option that may better suit your needs.

Would you like to get your questions answered about how best to fix your teeth?

Yes

First Name *

Last Name *

Phone *

Email *

Have you had an implant consult in the past? *

No, this will be my first time

Yes, I was a good candidate

Yes, but I needed bone grafting

Yes, but it was a long time ago

When are you thinking about starting treatment? *

I want to get started right away

I'd like to get started in the next 2-3 months

I'm considering getting an implant(s) in the next year

I am curious about dental implants but I have no plans to start treatment yet

When is the best time for us to call to schedule your appointment? *

Morning (8am-12:00am)

Afternoon (12pm-5:00pm)

Anytime (8am-5:00pm)