English | New Patient Forms


  1. Please, print both documents (DOC1-EN  & DOC2-EN).
  2. Fill the forms with your personal information.
  3. Bring them with you the day of your first visit.

English | Finance Options

We accept most PPO insurance plans, we will do all that we can to ensure your benefits are being used in the best way possible. To make life easier for you, we accept plans from many different insurance companies.  As a courtesy, our staff will promptly and efficiently process insurance claims and verify your benefits for you. If this is your first visit, please bring the necessary insurance information with you. We participate in some Health Management Organizations (HMO) plans. Please feel free to contact us to learn about the plans we work with. 

Payment Arrangements: we accept checks, cash or credit cards. We also offer a flexible payment plan. Please see our Financial Coordinator for details.

Financing Options: Our practice accepts most major credit cards and insurance plans, plus we offer affordable third-party financing options through CareCredit. With third-party financing, you can:

• Start treatment immediately.

• Enjoy low monthly payments.

• Finance up to 100 percent of the treatment cost.

• Choose between several payment options.

• Pay no costs up front.

• Pay no annual fees.

We accept CareCredit

Carecredit is the credit card exclusively for healthcare services. With no up-front costs and no pre-payment penalties, CareCredit lets you pay over time and frees up cash and credit cards for the other things you want or need. CareCredit offers low monthly payment plans for healthcare procedures not commonly covered by insurance, including dental treatments. Plus, you can use to pay for additional treatment for yourself or family members in any CareCredit practice.

CareCredit health, wellness and beauty credit card

For dental procedure financing

Think of CareCredit as your own health, wellness and beauty credit card. Whether it’s oral surgery, getting a crown or a general check up, you shouldn’t have to worry about how to get the procedures you want. That’s why we’re pleased to accept the CareCredit health, wellness and beauty credit card. CareCredit lets you say “Yes” to recommended surgical and non-surgical dental procedures, and pay for them in convenient monthly payments that fit your financial situation.

It’s free and easy to apply and you’ll receive a decision immediately. If you’re approved, you can schedule your procedures even before you receive your card. With more than 21 million accounts opened since CareCredit began nearly 30 years ago, they are the trusted source for healthcare credit cards.

Learn more by visiting www.carecredit.com or contacting our office.

You’ll be smiling brighter in no time!

Ready to apply? Walk-in with financing arrangements in-hand by clicking the link below for the location that works best for you.

Falls Church