• This form is for Innovative Smile traveling patients only. If you are local to the Springfield, MO area, please give us a call at 417-889-4746.

  • Format: (000) 000-0000.

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Unfortunately, we are unable to offer virtual consultations to those outside of the United States at this time.

  • How did you hear about Innovative Dental and Innovative Implant Smiles?*

  • Have you watched Dr. Olson's Innovative Implant Smile webinar?*
  • Do you intend on traveling to Springfield, MO to receive your Innovative Smile?*

  • Once we receive current x-rays, Dr. Olson will review your case and a team member will contact you to schedule a virtual consult. A non-refundable deposit of $150 is required to schedule the virtual consult. Should you move forward with treatment at our office, the $150 deposit will be applied to the cost of your treatment.

  • Unfortunately, we are unable to offer individual second opinions at this time.

  • How many teeth are you interested in fixing?*
  • When was your last dental visit?*

  • In order to proceed with a Virtual Consultation, we will need current x-rays. Upon submission of this form, you will receive information on sending your x-rays. 

  • In order to proceed with a Virtual Consultation, we will need current x-rays. Since it has been more than two years since your last dental visit, we recommend finding a local dentist to take x-rays. Upon submission of this form, you will receive information on sending your x-rays. 

  • Are you currently in Invisalign or traditional braces?*

  • Any buttons or brackets will need to be removed prior to receiving treatment at Innovative Dental.

  • What treatments are you interested in?

  • Have you looked into dental implants before?*
  • Do you currently have dental insurance?

  • Please be aware that we are not a Medicare/Medicaid provider.

  • Is this an individual plan or is it through your employer?*
  • Are you the subscriber on the policy?
  • Subscriber's Date of Birth
     - -
    2 digit month, 2 digit day, 4 digit year

  • Many cosmetic and implant procedures are not covered by dental insurance.

  • Have you given thought into how you'll be financing your Innovative Implant Smile?*
  • Financing Options
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