3089 West Fairview Road, Greenwood IN 46142

(463) 363-0702

What best describes the condition of your mouth? *

Missing a single tooth

Missing multiple teeth

Struggling with Full or Partial Dentures

Most of my teeth are in pretty bad shape

What dental procedures have you completed? *

Denture or Partial Denture

Bridge and/or Crown

Dental Implant

Most of my teeth are in pretty bad shape

What Improvements are you most interested in? *

I want to be able to eat the foods I love again

I want to feel confident smiling

I want to get out of pain

All of the above

Have you been told you have Gum Disease or Periodontal Disease? *

Yes

Do you have difficulty eating or chewing? *

Yes

Does your mouth cause you regular discomfort? *

Yes

Are you self-conscious about your appearance because of your smile? *

Yes

Upon credit approval or with the help of a cosigner, payment plans are available. Which best describes your credit? *

(Very Poor) Under 500

(Poor) 500-649

(Good) 650-749

(Excellent) 750+

I don’t know

It is unlikely you will get approved for financing with your credit score. How do you plan on paying for treatment? *

I have money to put down for treatment

I don't have finances or credit right now

We have many life-changing treatments that range from $5,000 - $10,000 - $15,000+ , this is based on your exam and exactly what you want. How much money can you put down for your new teeth? *

Less than $1,000

$5,000

$10,000

$20,000+

I have a family member with a 650+ credit score who is going to co-sign for my treatment

Based on getting approved for financing, can you afford $300-$900 per month? *

Yes

I will be paying cash

Is 3089 West Fairview Road, Greenwood IN 46142 commutable for you? *

Yes

What is your Zip code? (this helps us know that we are reaching people in our area) *

What is your Full Name? *

What is your best email address? *

What is your best phone number? *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

(463) 363-0702