Insurance Form

Simply Wisdom Teeth Insurance Information Sheet

Please complete this form to give us your most up to date Dental Insurance information. Once we have this information we will be able to give you an exact cost for having your wisdom teeth removed.

*PLEASE NOTE: This must be Dental Insurance, Wisdom Teeth will not be covered by Medical Insurance*

*The subscriber is the person who pays for coverage or who's employer offers the coverage*
*The following information can be found on the insurance card issued by your employer*

Great News!
You're eligible, but with different insurance plans the cost will vary between providers

We estimate pricing to be around $50-$600