NEW PATIENT FORMS

You don’t have to worry about coming into our office early to fill out new patient paperwork. Download, print, and fill out the information at home, then bring the completed forms with you to your first visit. Depends on your preferred language, down load the form and fill out HIPPA , 24hrs notice, Elelctronic communication consent forms

Download our New Patient Registration forms ( required)

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Download our New Patient Registration forms ( Spanish version )

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Download our new patient - medical history form ( Korean version)

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HIPPA & Office Policy Form ( Required )

Financial Consent Form  - Patient with Insurance coverage option  ( Required )

Financial  Consent Form - Patient with self-pay option ( Required )

General Dentistry information  & work  consent for exam ( Required)

Electronic Communication & Texting consent form ( Required )

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FINANCIAL INFORMATION

At Yong and Kim Dental, we offer you several convenient payment options. We appreciate your payment at the time of services rendered.

PROCEED FINANCE

Invest in your smile and your future with Proceed Finance. Proceed Finance offers extended repayment terms which makes it possible for patients to attain necessary treatment with affordable monthly payments.

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APPLY FOR PROCEED FINANCE 

CARECREDIT

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Are you a self-pay patient? Will insurance only cover part of your procedures? Don’t go without the dental services you need. You can receive special financing from CareCredit.  Pay within 24 at 0% interest.  

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APPLY FOR CARE CREDIT

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MAKE A CARE CREDIT PAYMENT

Click the link below to make a payment through Care Credit.
MAKE A CARE CREDIT PAYMENT

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ONLINE PAYMENTS

For patient convenience, we are happy to offer a safe online payment portal. If you have questions about your payment or need assistance accessing this service, please don’t hesitate to contact our team. We’re always happy to help. To get started, click the link below. Follow the instructions on the screen to access your payment plan for any current treatments. You’ll be able to enter in any major credit card to make your payment, and in some cases, you can use your CareCredit card.

SUBMIT A PAYMENT

(714)535-0192         

101 E. Lincoln Ave. # 100  Anaheim, CA  92805 

Office Hours

Monday 9:00 am - 5:00 pm 
Tuesday 9:00 am - 5:00 pm 
Wednesday 9:00 am - 1:00 pm 
Thursday 9:00 am - 5:00 pm 
Friday 9:00 am - 5:00 pm

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Featured Services

• Preventive Dentistry

• Checkups & Cleanings

• Periodontal Therapy

• Restorative Dentistry

• Crowns & Bridges

• Dentures & Partials

• Dental Implants

• Implant-Supported Dentures

• Cosmetic Dentistry

• Teeth Whitening

• All-Ceramic Restorations

• Emergency Dentistry

• See All Our Services

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