Patient Forms

Please take a minute to print and fill out the patient information forms before your first appointment:

  • Patient Form (Child) PDF | DOC
  • Patient Form (Adult) PDF | DOC
  • Patient Form (Child & Adult) PDF | DOC

If you’re unable to open PDF files, you can get Adobe Reader® for free.

Because every person is different, each person’s treatment is individualized and customized according to the person’s need and situation. If the patient is a child, we strongly recommend both parents/decision-makers be present, if that is possible. Otherwise, the absentee parent will only know the two numbers (treatment cost and treatment time) and never experience the superior level of care and tremendous value we provide to the patients.

We don’t want the treatment cost to be an obstacle to a wonderful smile. Again, because everybody’s situation is different, we can make financial arrangements to fit each individual’s budget and need.  

Orthodontic insurance: If possible, please give us your insurance information before you come to consultation.

If you have orthodontic insurance, you can make the consultation process very productive and smooth if you can give our staff the necessary information (subscriber name, SS#, birthday, etc.) a few days before the consultation to verify your coverage. Without coverage verification, we won’t be able to give you the complete picture of what your financial responsibilities are.

We do NOT charge/file your insurance for any procedure unless you start treatment with our office. We may not be able to get the verification if you give us the insurance information on the same day of your consultation, because it may take a long time (one to two hours) to get the complete insurance information.

Another reason is that the insurance companies could be on the East Coast, which has a three-hour time difference with California; 3:00 p.m. here means it’s 6:00 p.m. in New York. Most of these insurance companies close by 5:00 p.m. their time.

If you want our office to contact you to make an appointment, please fill out the following information and the best time to call you. When you are on the phone, our staff will ask if you want us to verify your insurance. Of course, we respect your decision if you do not want to provide any insurance information. We are here to help you!!

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