Patient Information

Your First Appointment

Please fill-out the forms in this packet and bring them to your first appointment:

• New Patient Packet
  (Patient information/Health history/Privacy practices)

Also, please bring the following:

• Patient's insurance card
• List of current prescriptions and/or over-the-counter medication, including dose and frequency
• Information about patient's medical and surgical history
• Recent test results, x-rays, or relevant records

Financial Policies

We believe firmly that financials should not be the obstacle that prevents you from having the treatment that you desire and is necessary in most cases. We are sensitive to the fact that different patients have different needs and various financial situations.

We assist you in complete confidence to find a means of making your treatment affordable with different payment options. The fees charged in this office are comparable to those charged by others in our area.

Insurance and Payment Information

Payment Options:

As a courtesy for payment in full, a discount can be applied for cash patients. We also offer a Senior Citizen discount.

We accept VISA, MasterCard, American Express, Discover, Cash, Checks and Care Credit.

Insurances Accepted:

Most PPO insurance plans are accepted. If you are utilizing your insurance we do collect your Estimated patient portion in full on the day of service. We gladly process your insurance forms for you with an assignment of benefits payable to our office.

Please be aware that this is a courtesy of our office and that your insurance policy is a contract between you and your insurance company. We encourage you to read your insurance benefit book provided by your insurance company to better understand the specifics of your coverage.

Please bring your insurance card and drivers license with you to your scheduled appointment, we do need to make a copy for your patient chart for verification. We do understand at times the insurance does not provide cards for Dental so please have the Primary Card Holder’s information with you.

If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Hospital Affiliations

• Mission Hospital
• Children's Hospital of Orange County (CHOC) at Mission Hospital

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.