Welcome to the family!

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New Patient Forms

If you are a new patient to our office, please print these three forms, fill them out, and bring them to your first visit: 

1. Registration Form

2. Medical History Form

3. Office Policy Form

Formularios en Español

Si usted es un paciente nuevo de nuestra oficina, favor de imprimir estos tres documentos, llenar su informacion, y traerlos a su primera cita:Registration Form

1. Fomulario de Polizas

2. Folmulario de Registro

3. Folmulario Medico

Other Forms

• Dental Pre-Medication Form

• Records Release Form

Payment Options / Insurance Financing

Make a payment online!

Insurance & Financing

Dr. Mondragon and his Team, believe quality dentistry should be accessible by everyone. We work with our patients, not against them, to help them understand and maximize their insurance benefits or come up with a flexible payment plan that fits their budget.

We accept all PPO insurance plans that allow you to choose a dentist you trust. In order for us to provide the high level of service and patient care we believe in, we are not an “in-network” provider and cannot accept HMO plans. We file all your insurance claims for you and collect the insurance portion of your fee directly from your insurance company.

If you don’t have dental insurance, no worries. We are happy to accept cash, personal checks, and major credit cards, and offer a 5% courtesy discount on prepayments for treatments over $300.

CareCredit®

CareCredit® is one of the leading healthcare credit cards and is accepted at over 175,000 providers nationwide. CareCredit® works just like any other credit card but is used strictly for healthcare expenses, including dentistry. Pay upfront for necessary procedures, and make affordable monthly payments that work with your budget. CareCredit® financing is flexible, convenient, and the application process is simple.

Online Payment

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We accept Apple Pay.