Patient Forms

Your First Visit

Welcome and thank you for choosing us as your partner in dental health. To support you in making your appointment more relaxing we've made our new patient forms available here. At your convenience, please print and bring the completed forms to your first visit. Also, please bring with you a photo ID, your insurance card and method of payment.

If you have any questions, please call and any member of our team will be happy to assist you. We look forward to serving you.

New Patient Registration, Notice of Privacy Practices and Financial Policy

For your convenience we accept MasterCard and Visa. We also offer financing options available through CareCredit.

We deliver the finest care and service at the most reasonable cost. Therefore, payment is due at the time services are rendered unless other arrangements have been made in advance with our financial coordinator. If you have questions regarding payment, applying for financing or your account please call our friendly team at (949) 348-1212.


Dr. Moon and Liliana