Resources & Forms

New Patients

If you prefer to fill out your new patient paperwork ahead of time, please use one of the following two options. Please do not submit paperwork until AFTER you have scheduled your appointment by phone and at least 48 business hours before your appointment.

Please choose one option: Print or Online

OR

En Español:

HIPAA Policy

We will ask you to review and sign our HIPAA statement at your first appointment. If you prefer to read it ahead of time, or need to revisit it, please visit the link below:

Financial

We will also ask you to read and sign our Financial Policy at your first appointment. If you prefer to read it ahead of time, or need to revisit it, please visit the link below:

 

 

If you have dental insurance, we will gather information and file dental claims as a courtesy for you. Whether or not we are in-network, we receive payments from many dental insurance providers.

If you do not have dental insurance or are not covered at our office, we can offer discounts on cash, check, debit, and credit payments.

 

We also accept Care Credit

Interest-free for 6 or 12 months

No additional discount applies

 

Consent Forms

If Dr. Chou recommends treatment and you schedule with us, you will need to sign relevant consent forms in office before your appointment. These forms are available below should you need to reference them. Please do not submit consent forms - we will do this in office on the day of your appointment.

Online Referral Form

For dental office use only. To refer your patient, please fill out the following online form as thoroughly as possible and send all relevant records to get your patient scheduled in a timely manner.