Patient Forms

For your convenience, you can download our patient forms. Simply click on the desired form below and you will be able to access the download using Adobe Reader. If you need the reader to view, please click here for the free download.

 

Patient Registration
Consent Form

 

Financial Arrangements

At Jeff C. Robertson, DDS, our goal is to maximize your insurance benefits and make any remaining balance easily affordable. If you have any questions regarding your insurance benefits, please don't hesitate to call our office at (714) 838-7272 to review your concerns.

 

Our fees are based on the quality of the materials we use and our experience in performing your needed treatment. To facilitate our goals, we have developed the following financial options:

 

A 5% accounting adjustment is allowed when fees in excess of $300 are paid in full by cash or check on the day that treatment is presented or in advance of scheduling the appointment.

 

Major credit cards, such as Visa, MasterCard, Discover and American Express, are accepted in our office.

 

You may finance your dental treatment through a company utilized by our office. We will supply the forms and secure approval for you.

 

We offer financing through CareCredit.

 

Senior Citizens: A 10% courtesy allowance is given for senior citizens. (No combining of discounts).

If you would like to review our financial arrangement options in advance of treatment, please call (714) 838-7272.

 

Office Hours

Monday - Thursday
7:30AM - 4:30PM

Friday
By Appointment Only