New Patients

New Patients

Patient Information Form:

Medical History Form:

Acknoledgement Receipt of Privacy Polict Form:
Consent general Form:

Dental Materials Fact Sheet Form::

Financial Policy Form:


Your smile conveys confidence, friendliness, beauty and much more. Don’t let money stand in the way of a beautiful smile for you.

It is very important to us that the cosmetic and implant dentistry treatments we recommend are affordable. We’ll work with you to plan a financing program designed to fit your needs. You will be able to choose between a variety of payment options including:

• Cash
• Check
• Charge credit card
• Pre-authorized monthly credit card charge and financing
• Flexible Spending Account (FSA) / Out of pocket healthcare costs

Financing your Dental work

We offer easy financing through CareCredit

About Care Credit

CareCredit offers a full range of No Interest and Extended Payment Plans for treatment fees from $1 to over $25,000 with the following options:
• No Interest Payment Plans (Terms & Conditions)
• 3, 6, 12, & 18 month plan options
• No interest if the balance is paid within the specified time period
• Low minimum monthly payments
• Extended Payment Plans (Terms & Conditions)
• 24, 36, & 48 month plan options
• For treatment fees from $1,000 to over $25,000

With CareCredit, you pay no up-front costs, no pre-payment penalties and no fees. Plus, CareCredit is a revolving credit line for additional treatment or add-on charges, without the need to re-apply. You can view their estimated payment calculatoror apply online. Change your life with a smile that lasts forever. Apply now or learn more about our payment plans. Smile LA In-House Dental Benefits Plan

Available to all patients

• No premiums
• No claim forms
• No treatment limits or restrictions
• No waiting periods

Membership Includes complimentary:
• Check Up and Emergency Exams
• Digital X-Rays (if needed)
• Two routine cleanings per year
• Periodontal Evaluation
• Oral cancer screen
• Oral Hygiene instruction
• TMJ Screening
• 20% off dental services

*prescriptions, arestin/anti-biotic, mouthwash or tooth paste are excluded. A treatment plan will be provided in writing for all recommended procedures displaying the regular fee and discounted rate.
Annual Price: $295
Coverage is in effect for one year. Coverage begins when the membership has been paid in full.
Insurance Accepted

You may be able to use your own dental insurance if you have a policy that allows you to choose your own dentist. If this is the case, we are happy to file your insurance claims for you so that you can be reimbursed by your insurance company. Dr. K. Yousefzadeh and the team at Smile L.A. Modern Dentistry in Los Angeles, CA are proud to offer excellent dental care at an affordable price. If you have any questions or concerns about insurance and financing options, please contact our office.
View full list of companies
Network Insurances
• Aetna
• Aflac
• Ameritas
• Anthem Blue Cross Blue Shield
• Assurant Employee Benefits
• Cigna
• Delta Dental
• Dental Benefit Providers
• Guardian
• Humana
• Lincoln Financial Group
• MetLife
• Mutual of Omaha
• Principal Financial Group
• United Concordia Dental
• UnitedHealthcare
Smile LA Downtown Modern Dentistry 523 West 6th Street, Suite 202 Downtown Los Angeles, CA 90014 Phone: +1 213-DENTIST (336 8478)
Monday8:00am - 5:00pmTuesday7:00am - 4:00pmWednesday9:00am - 6:00pmThursdayClosedFriday8:00am - 5:00pmSaturdayClosedSundayClosed GET IN TOUCH +1 213-DENTIST (336 8478)