New Patient Forms
We have made our new patient forms available to you as Adobe Acrobat files. For your convenience, we recommend printing and completing these forms at home.
Please remember to bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our Los Angeles, California office and we will gladly send or fax them to you.
We offer affordable payment options while providing premium quality dental care!
Cash: This includes money orders and personal checks.
Credit Cards: Cards accepted include Visa, Mastercard, American Express, and Discover.
Third Party Financing: This is a separate line of credit that can cover your entire family's dental treatment. It does not affect your current spending limits and balances of your other cards. There is no annual fee, no pre-payment penalty, and no interest if paid by the due date. Monthly payments need only be 3% of the total balance. Our Financial Affairs Counselor can fill in all the details for you.
Our Financial Policy
Insurance & Financing: We accept most major insurance plans and will assist you in obtaining the maximum benefits your plan provides. Our patients are informed of their estimated insurance benefits prior to starting any treatment. While your insurance is a contract between you and your carrier, we will accept an insurance assignment of benefits. Your estimated co-payment and any deductibles are due at the time of service. We accept Visa, MasterCard, Discover, and American Express. We also offer payment plans through a third party.
Non-Insurance Patients: Payment is due at the time of treatment and may be paid by any of the listed payment options.
Insurance Patients: We understand the value of insurance benefits and will assist you in obtaining your maximum benefit. We will gladly process your insurance claim for you and will also estimate the portion that is not covered by insurance. This co-payment amount is due at the time of treatment and may be paid by any of the payment options listed above. Our estimates are based upon the information that you have provided us regarding the benefits of the insurance plan your company has chosen.
We are not party to your insurance contract and we therefore cannot guarantee what your insurance will cover. Any balance not paid by insurance within 60 days due to insurance company delay or because forms were not provided at the time of treatment will be the patient's responsibility.
Initial Payments: With all payment options, a deposit of one-half of the patient’s co-payment is required at the start of treatment, with the balance due on or before the day of completion and delivery. Please click here to email our office for questions about financing, insurance, and payment options.