Smile Center NY
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Offers & Discounts
Free Consultation and 2nd Opinion
No Insurance? No Problem
Patient Reviews
Blog
Contact Us
ECMC Employees
Smile Makeover Open House
Menu
Home
About Us
Dr. Scott D. Geise
Our Amenities
Smile Gallery
MEET THE STAFF
Services
Immediate Dentures
Sedation Dentistry
Dental Implants
Invisalign
Cosmetic Dentistry
Dental Care
Emergency Dentist
Teeth Whitening
Extractions
Fillings
Root Canals
Crowns & Bridges
Offers & Discounts
Free Consultation and 2nd Opinion
No Insurance? No Problem
Patient Reviews
Blog
Contact Us
ECMC Employees
Smile Makeover Open House
716-634-4090
REQUEST AN APPOINTMENT
DIRECTIONS
Home
About Us
Dr. Scott D. Geise
Our Amenities
Smile Gallery
MEET THE STAFF
Services
Immediate Dentures
Sedation Dentistry
Dental Implants
Invisalign
Cosmetic Dentistry
Dental Care
Emergency Dentist
Teeth Whitening
Extractions
Fillings
Root Canals
Crowns & Bridges
Offers & Discounts
Free Consultation and 2nd Opinion
No Insurance? No Problem
Patient Reviews
Blog
Contact Us
ECMC Employees
Smile Makeover Open House
Menu
Home
About Us
Dr. Scott D. Geise
Our Amenities
Smile Gallery
MEET THE STAFF
Services
Immediate Dentures
Sedation Dentistry
Dental Implants
Invisalign
Cosmetic Dentistry
Dental Care
Emergency Dentist
Teeth Whitening
Extractions
Fillings
Root Canals
Crowns & Bridges
Offers & Discounts
Free Consultation and 2nd Opinion
No Insurance? No Problem
Patient Reviews
Blog
Contact Us
ECMC Employees
Smile Makeover Open House
716-634-4090
DIRECTIONS
REQUEST AN APPOINTMENT
Dental Implant
Dental Implants - BUFFALO, NY
DENTAL IMPLANT EVALUATION
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
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Step
1
of 12
What Best Describes Your Condition? *
I Have All My Teeth
I'm Missing One Tooth
I'm Missing Multiple Teeth
I'm Missing All My Teeth
Next
How Long Have You Been Missing Your Teeth? *
I'm Not Missing Teeth
Less Than A Year
More Than A Year
Next
Do You Currently Have Any Of The Following Treatments? *
Crowns and/or Bridges
Partials
Dentures
None of the Above
Next
Have You Experienced Any Type Of Insecurities Regarding The Way Your Teeth Look? *
Yes
No
Next
Does Your Condition Have A Negative Impact On Your Ability To Eat or Chew Certain Foods?
Yes
No
Next
What Is The Most Important Outcome You Are Seeking? *
Function - Eating, Chewing, Talking
Aesthetics - Beautiful, Natural Looking Teeth
Both Are Equally As Important
Next
What Is The Most Important Factor That Has Prevented You From Getting Treatment? *
Time
Money
Fear
Can't Find The Right Dentist
Next
What Is your Level of Urgency To Find Relief From Any Type Of Pain Or Discomfort That You May Be Feeling? *
1 - Very Little, I'm Not In A Rush
2- Moderate, I-3 Months
3 - High, I'm Looking For Help Now!
Next
Have You Had Treatment Plans From Other Doctors For Dental Implants Recently? *
Yes
No
Next
Most Dental Implant procedures are not covered by insurance. However we offer many payment plans that make it quite affordable and offer low monthly rates. Are you interested in a payment plan?
*
Yes I am!
No I will not need a payment plan
Are You Interested in Learning About Our Easy Monthly Payment Plans? If So, What Dollar Range Would You Like To Pay Monthly
*
No Financing
$50-149/Month
$150-$249/Month
$250-349/Month
Over $350/Month
Next
Payment plans are based on credit approval, you may also bring in co-signer. If you could guess, what is your credit score?
*
500- 550
551 - 600
601 - 650
651 - 700
701+
I don't know my credit score
Next
Name
*
First
Last
Phone
*
Email
*
Postal Code
*
Custom Captcha
*
What is 4+4?
Submit
