Dentist and clinics

Treatment cost estimator

Choose the treatment and how many teeth: the estimated cost is worked out live. This form uses FillKite Pro.

PRO · Calculation · Logic

Pro demo

Treatment cost estimator

Fill it in and press the button to see how it behaves. Nothing you type is saved or sent.

What is in this form

Your name (required)
Email (required)
Fillings needed (required)
Crowns needed (required)
Hygienist clean? (required)
Estimated cost
Do you have dental insurance?
Insurance provider

How the conditional logic works

This form shows or hides fields as people answer, so everyone sees only what matters to them.

“Insurance provider” appears only when “Do you have dental insurance?” is “Yes”.

What FillKite Pro adds

This form uses calculation, logic, which need FillKite Pro. You can try it here for free. The download works on a site that has FillKite Pro.

Questions

About this form

Is the treatment cost estimator form free?

You can try it here for free. The form uses calculation, logic, which need FillKite Pro, so the download works on a site that has FillKite Pro.

Is anything I type saved?

No. This demo runs in test mode: FillKite checks your answers like a real form, but nothing is saved and no email is sent.

How do I use this form on my site?

Install FillKite, download the form with the button on this page, then go to FillKite → Import → From a FillKite file and choose the file. After importing, open it in the builder, change anything you like and add it to a page.

Does this form use conditional logic?

Yes. 1 field or notice shows only when earlier answers call for it. “Insurance provider” appears only when “Do you have dental insurance?” is “Yes”.

What fields does it have?

It has 8 fields: Your name, Email, Fillings needed, Crowns needed, Hygienist clean?, Estimated cost, Do you have dental insurance?, Insurance provider.

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FillKite Pro

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