Payment Solutions

Single tooth implants can be as low as $99 per month. A full mouth restoration can be as low as $250 per month dependent upon your treatment plan, credit score, and current interest rates.

We accept major credit cards, cash and most dental insurance.

For your comfort and convenience, financing options are available to help make your dream smile become a reality. These financing options are unavailable at most dental offices providing dental implants. You are welcome to submit a credit application for us to complete a soft credit check to get you pre-qualified for solutions. This soft credit check does not affect your credit rating.

Financing

**If not applicable, please type: 'None'

Personal Information

---

DOB

Current Address

---

Treatment

---

Requested Treatment ↓ Single Implant Upper All-On-4 Lower All-On-4 Upper & Lower All-On-4 Multi Tooth Implants Implant Crowns Implant Supported Dentures Full Mouth Rehabilitation

Housing

---

How Long At Current Residence? ↓ Less than a month 1-11 months 1-2 years 2-3 years Over 3 years

Current Housing Type

Mortgage Loan
Rent
Own Free and Clear
Living with Family
Leasing
Board
Other

Previous Address

---

How Long At Previous Residence? ↓ Less than a month 1-11 months 1-2 years 2-3 years Over 3 years

Previous Housing Type

Mortgage Loan
Rent
Own Free and Clear Living with Family
Leasing
Board
Other

Current Employment

---

Employment Status

Full Time
Part Time
Self-Employed
Not Employed
Homemaker
Retired
Student

Employer Address

---

Previous Employment

---

Previous Employer Address

---

Income

---

Additional Income

Alimony
Child Support
Rental Property
SSI
Disability
Other

Do You Have A Co-Applicant? Y N

If yes, please provide their name. Co-Applicant will need to submit a credit application as well.

I, the applicant, have agreed for Dental Implant Center of Oklahoma to run a soft credit check on me. I understand that their financial institutions may run and review my credit report and personal information to obtain a finance solution for future treatment with Dental Implant Center of Oklahoma. This is not an obligation on my part to comment on treatment or use any credit offer that may be extended to me for payment of the services provided by Dental Implant Center of Oklahoma. It is only provided as an courtesy in exploring my financial options.

I Agree

If you're human leave this blank:

Medical History Form