14560 River Rd Suite 105 Carmel, IN 46033 317.764.2938 14560 River Rd Suite 105 Carmel, IN 46033 317.764.2938 MenuOur DifferenceTeamServicesMaintain Your SmilePreventive DentistryChildren’s DentistryToothachesCustom-Fitted Dental Mouth GuardTMJ/ Bruxism SplintsTooth ExtractionSedation DentistryStop Snoring with Snore Guard AppliancesDental EmergenciesRestore Your SmileDental ImplantsRobot-Assisted Dental Implant SurgeryImplant Dentures and BridgesFull, Partial & Implant DenturesDental Crowns & BridgesPeriodontal Gum TreatmentRoot CanalsEnhance Your SmileTeeth WhiteningVeneersCosmetic BondingInvisalign® Clear BracesNew PatientsRead Our ReviewsNew Patient SpecialsYour First VisitPayment OptionsBefore & After PhotosComplete New Patient FormsSafetyLocationSchedule Now Our DifferenceTeamServicesMaintain Your SmilePreventive DentistryChildren’s DentistryToothachesCustom-Fitted Dental Mouth GuardTMJ/ Bruxism SplintsTooth ExtractionSedation DentistryStop Snoring with Snore Guard AppliancesDental EmergenciesRestore Your SmileDental ImplantsRobot-Assisted Dental Implant SurgeryImplant Dentures and BridgesFull, Partial & Implant DenturesDental Crowns & BridgesPeriodontal Gum TreatmentRoot CanalsEnhance Your SmileTeeth WhiteningVeneersCosmetic BondingInvisalign® Clear BracesNew PatientsRead Our ReviewsNew Patient SpecialsYour First VisitPayment OptionsBefore & After PhotosComplete New Patient FormsSafetyLocationSchedule Now Are you a candidate for Dental Implants or Implant Dentures? Take our one minute quiz below to find out! Your information is safe, secure and will only be used to contact you about your consult. Please be sure to fill out all fields marked with an *.Step 1 of 333%What is your zip code?*What is your biggest dental challenge? (Select all that apply)* I am missing a single tooth I am missing multiple teeth I am struggling with my traditional dentures Most of my teeth are broken, decayed or missingHow long have you been struggling with this?*Select OneLess than one monthLess than six monthsLess than a yearMore than a yearWhat has kept you from fixing your smile? (Select all that apply)* Nothing! I am ready right now. Cost of dental procedures Fear of dental procedures Time involved in dental procedures Have not found a dentist that I am comfortable with yetIf it was affordable, how soon would you be ready to move forward with treatment?*Select OneNowIn the next 30 daysIn the next 6 monthsI am in no rush, just researching optionsHow do you plan to pay for your dental implant treatment? (Select all that apply)* Cash Credit Card Dental Insurance Healthcare Financing (CareCredit, GreenSky) I would like to learn more about financing options / payment plansWhat is your current credit score range?*Select OnePoor (350-550)Fair (550-650)Good (650-720)Excellent (720+)I don’t know my credit scoreSelect the option that best describes your situation.*Select OneI can afford monthly payments of $499 and have money to put downI have a set amount of cash that I can spend and need help finding a treatment plan that fits my budgetI am prepared to pay for my entire treatment up frontI do not currently have any money to afford treatmentHave you spoken to another dentist about treatment?*Select OneYes, I would like a second opinionNo, this will be my first consultationWhat was the price range of the other dentist’s treatment plan?*Select One$500-$2,000$2,000-$5,000$5,000-$10,000$10,000-$20,000$20,000-$30,000More than $30,000What is most important to you about your implant dentist? (select all that apply)* Lowest cost Experience placing implants Delivers highest quality Financing options Gentle and CaringName* First Last Email* Phone*Please prove that you are not a robot by solving this problem: 4 + 3 =*EmailThis field is for validation purposes and should be left unchanged.
