Consult Form

IMPORTANT NOTE: whatimplantisthat.com is owned and operated by Infodontics, LLC and the receipt for your payment will show as coming from Infodontics, LLC, not from whatimplantisthat.com.

Please fill in the form below to let us know some details about your patient’s implant(s). The more you can answer about the implant, the more likely we will be able to help you figure it out.*


Enter Your Information

*required field.

*Doctor's Name


Contact Name:


Contact Number:


Office Website:


*Email (Use a commonly checked email):


*Confirm Email:


How did you hear about us?:


*Select Number of Unique Implants
Note: You will be charged $125 for identification of a single implant type,
plus $35 for identification of each additional implant (if a patient has multiple implant types).




*Implant Site Number(s):


WHEN implant was placed (Year)?:


WHERE the implant was placed (City, State, Country)?:


Comment:


*Select Files




Depending on file sizes this may take a long time, please be patient

*Note that if identified, your radiograph will likely be included in our database to assist future users in identifying implants. Please let us know if you have any objections to this.

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