Which services are you looking for? Regular checkup Remove/ Treat a sore tooth e.g. fillings Hygienist services Teeth whitening Orthodontics/ Teeth straightening Dentures Veneers Root canal treatment Bonding Emergency tooth extraction Teeth Cleaning & Checkup Tooth Pain / Emergency Fillings or Cavities Dental Crowns Braces or Invisalign Dental Implants Gum Treatment Not Sure (Need Evaluation) Next Which of the following applies to you? Out of pocket payment Private insurance (Market Place) Medicare/ Obamacare/ Medicaid Prev Next How many teeth are affected? 1 tooth 2 teeth 3-5 teeth 6-10 teeth The whole mouth Prev Next When did you last visit the dentist? Within the last month 1-3 months ago 4-6 months ago 7-12 months ago Over a year No prior visit Prev Next How soon do you need the appointment? Within 24 hours 2-5 days Next week Next month 2-3 months Unsure Prev Next What is an estimate of your annual income? Less than $20,000 $20,000 - $50,000 $50,000 - $80,000 $80,000 - $100,000 Above $100,000 Prev Next Do you have dental insurance? Yes No Not Sure Prev Next If yes, what type? Prev Next How do you plan to pay if treatment is needed? Insurance Cash / Self-Pay Financing / Payment Plan Not Sure Prev Next AvailabilityBest days to be contacted: Monday Tuesday Wednesday Thursday Friday Saturday Prev Next Best time of day: Morning Afternoon Evening Anytime Prev Next Please describe your dental need Prev Next Choose your state Please selectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Prev Next City and zip codePlease ensure you type in the correct city name and zip code to help our dentist find your request Prev Next We need your details to confirm your appointment Prev Next ConfirmationConsent & submission I agree to be contacted by a dental clinic regarding my request if I qualify. I consent to receive calls or texts related to my dental care. Check if I Qualify
