Contact Dental Solutions of Binghamton Call us to make an appointment Contact Form LinkedInThis field is for validation purposes and should be left unchanged.Patient InformationName(Required) First Last Phone(Required)Email(Required) Enter Email Confirm Email Preferred Contact Method(Required)Phone CallText MessageEmailAre You a New or Existing Patient?(Required)New PatientExisting PatientReason for Contact(Required)Dental ImplantsHybridge ConsultationNew Patient AppointmentEmergency AppointmentHygiene / CleaningGeneral QuestionOtherHow soon would you like to be seen?As soon as possibleWithin 1 weekWithin 2–3 weeksFlexibleWhat City do you call home?(Required) City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Are you interested in learning about Hybridge dental implants?Yes – I want a consultationYes – I’d like to attend a seminarI’m not sure yetNoPlease select seminar date(Required)6/18/2411/16Best Time to Contact You?(Required)MorningAfternoonEveningAnytimePlease let us know if you are missing teeth, have loose or failing teeth, have dentures that move or are uncomfortable, experiencing difficulty chewing certain foods, or are exploring long-term solutions, gathering information, or to obtain a second opinion(Required)Please share any details about your dental concern.Have you previously been told you need dental implants or full mouth reconstruction?(Required)YesNoI’m seeking a second opinionHow did you hear about us?(Required)Google SearchFacebook/InstagramCommunity EventFriend / FamilyTV – Wellness Hour commercial – 30 MinuteTV – Lasting Smile Commercial – 30 MinuteInternet SearchRepeat PatientAnother DoctorWhich doctor referred you?(Required)Insurance InformationDo you have Dental Insurance?(Required)Delta DentalExcellusCignaAetnaGuardianMetLifeUnited ConcordiaFidelis (Medicaid)Medicaid Managed PlanMedicaidMedicareOtherI Do Not Have InsurancePlease list your insurance provider:(Required) Insurance Notice: Insurance-Independent Dental Care Dental Solutions of Binghamton is an insurance-independent, fee-for-service practice. Payment is due in full at the time of service. As a courtesy, we may submit claims to eligible commercial dental insurance plans; however, any out-of-network reimbursement is paid directly to the patient. Dental Solutions of Binghamton does not receive payment from insurance companies. Financing options available: • Proceed Finance • CareCredit • LendingClub • Cherry Finance(Required) I understand that I am responsible for payment in full at the time of service or must have financing arrangements secured before receiving care.Financing options available: • Proceed Finance • CareCredit • LendingClub • Cherry FinanceImportant Medicare and Medicaid Notice: Dental Solutions of Binghamton does not participate with Medicare, Medicaid, Fidelis Medicaid, or Medicaid-managed plans. Patients with these plans may still choose to receive care as self-pay patients, but payment is due in full at the time of service or financing arrangements must be secured before treatment. (Required) I understand that Dental Solutions of Binghamton does not participate with my plan and that I will be personally responsible for the full cost of my care.HIPAA Consent DisclaimerBy submitting this form, you consent to being contacted by Dental Solutions of Binghamton. CAPTCHA 607.798.0789 Call Us to schedule your appointment 205 Oakdale Rd., Johnson City, NY 13790 Office We offer financing options:
