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8325 S Emerson Ave Suite A Indianapolis, IN 46237
Patient Info

Patient Info

SCHEDULE APPOINTMENT

Your Time is Valuable – So Get a Head Start

We’ve provided all of our new-patient forms online here so you can get a jump start on your treatment time with us. If you complete these forms prior to your initial appointment, you won’t have to arrive 15 to 30 minutes earlier to rush through filling them out before your appointment. Fill out these forms and submit them from home, then on the day of your appointment, just come on in, let us know you’re here, and we’ll be up to get you soon after you arrive.

New Patient Forms

We sincerely value your time. To make things as uncomplicated as possible, we have made our patient forms available online. Easily print the forms, fill them out on your own time, and bring them with you to your appointment. Spend less time filling out paperwork, and more time on what matters most — your dental experience!

New Patient Forms

Wherever life takes you, we've got you covered. Ask about our nationwide, life proof smile protection.

Financing

We work diligently on your behalf with the majority of dental plans and gladly will register your claim with your insurance firm to maximize your benefits. Co-payments and deductibles (the portion the insurance does not cover) are due at the time services are rendered. To process claims accurately, patients must provide us with correct and relevant insurance information as well as inform us of any changes regarding their dental insurance at the time of treatment. Please keep in mind, most dental insurances do not cover cosmetic procedures.

Our office is devoted to making your treatments as easy and affordable as possible. We believe that it is essential for everyone we see to be educated and informed about the procedure that they are interested in.

Financial preparation for what can be a substantial purchase is necessary, and we would like you to be well-advised about the cost and payment options that are available to you. Below you will find some practical information to assist in deciding which form of payment will work best for you and your individual obligations.

CareCredit

Alphaeon Credit

Membership Plans

No Insurance? No Problem!

Dental coverage for less than the cost insurance… YES! Learn more about our In-House Savings plan!

  • Price transparency
  • Enroll anytime
  • NO yearly maximum benefit limit
  • NO waiting preriods
  • NO pre-authorizations
  • NO deductibles
  • NO missing tooth clause/pre-existing condition/exclusions
  • NO one denied coverage
  • Plans cannot be used in combination with dental insurance
  • Plans EXCLUDE: Cosmetic procedures, Botox, and Filler

THE FINE PRINT
*Please Note: When signing up for your dental membership plan, we have an auto-renewal policy. Your payment method on file will be utilized automatically AND annually on the original date you purchased your membership plan. our fees will increase ecah year, by agreeing with our terms, your membership plan cost will remain as the same rate. Should your coverage lapse due to invalid payment information, we cannot honor the original membership plan price as our fees go up annually. Please note, benefts do NOT transfer from one family member to another. Your membership plan is specific to our dental office and cannot be utilized at another practice.

Choose a care plan that best fits your needs

Adult Prophylaxis Plan

Ages 13 & Up

$525/yr.

  • 2 Periodic Exams
  • 1 Oral Cancer Screening
  • 1 Emergency Exam
  • All Radiographs as Needed
  • 2 Prophylaxis Cleanings
  • 2 Fluoride Treatments
  • 20% Off All Dental Treatment
  • 10% Off Clear Aligner Treatment
  • $25 Off Each Additional Family Member (Same Household)

Child Prophylaxis Plan

Ages 12 & Under

$425/yr.

  • 2 Exams
  • 1 Oral Cancer Screening
  • 1 Oral Cancer Screening
  • 1 Emergency Exam
  • All Radiographs as Needed
  • 2 Prophylaxis Cleanings
  • 2 Fluoride Treatments
  • 15% Off All Dental Treatment
  • 10% Off Clear Aligner Treatment
  • $25 Off Each Additional Family Member (Same Household)

Periodontal
Plan

 

$849/yr.

  • 2 Periodic Exams
  • 1 Oral Cancer Screening
  • 1 Oral Cancer Screening
  • 1 Emergency Exam
  • All Radiographs as Needed
  • 4 Periodontal Maintenance Cleanings
  • 2 Fluoride Treatments
  • 20% Off All Dental Treatment
  • 10% Off Clear Aligner Treatment
  • $25 Off Each Additional Family Member (Same Household)

WE KNOW BUDGETS ARE IMPORTANT

Give us call and we can help you find the best options for you.

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