New Patient Forms and Policies

Welcome to our Beverly Hills dental practice. As a new patient, please review and complete the following dental forms to streamline your visit. Filling them out ahead of time will help us address your medical needs more efficiently.

New Patient Forms

Attached, you’ll find our new patient bundle, which includes essential forms that need to be completed. The bundle contains:

• Health History Form: Provides details about your medical and dental history.
• Financial Policy Agreement: Outlines our billing practices, including insurance coverage.
• Office Cancellation Policy: Details our procedures for appointment cancellations and no-shows.
• Patient Questions and Communication Consent Form: Ensures we have your consent to communicate with you effectively.

Please print these forms, fill them out, and bring them with you to your appointment. This will allow us to address your needs more quickly and efficiently.

Insurance and Financial Policy

As your Beverly Hills dentist, we’re happy to bill your private insurance company on your behalf. To do this, we need complete insurance information and confirmation of your coverage. Please ensure you fill out all required forms accurately.

Please note:

• Any costs not covered by insurance are due at the time of service.
• If your insurance does not pay within 90 days, you will be responsible for the balance.
• Handle insurance issues directly with your insurance company. We will provide any necessary information to assist in resolving these issues.

By signing the Financial Policy Agreement, you acknowledge and agree to honor your financial commitment to our office.

Office Cancellation Policy

As your Beverly Hills dentist, we set aside specific time slots for each appointment to ensure personalized care. Please notify us at least 48 hours in advance during business hours if you need to cancel or reschedule. Note that our office is closed on Wednesdays and weekends. Your cooperation helps us maintain high standards of oral health care for all our Los Angeles patients.

Late cancellations or no-shows will result in a $40 fee, not covered by insurance. As your dentist in Beverly Hills, we may ask you to find another dental office if you miss or cancel three consecutive appointments. By signing the Office Cancellation Policy, you agree to these terms and conditions.

Communication Consent

The Patient Questions and Communication Consent Form gives us permission to contact you about your dental care and office matters.

If you have any questions or need assistance with these forms, please do not hesitate to call our office.

We are here to help and ensure your visit is as smooth as possible. Thank you for your cooperation and understanding. We look forward to providing you with exceptional dental care.