dr. al manesh
26800 Crown Valley Pkwy
Suite #425, Mission Viejo,
Office: (949) 364-2935get directions
Your First Visit
What to Expect
At the Mission Dental Implant Center, we care about each patient who walks through our doors. We will complete an in-depth medical and dental health history and do a thorough exam to assess for the following conditions: gum inflammation and pocket depth, bone loss and density, loose teeth, and other signs of periodontal disease. We may also take x-rays and/or a CT scan to assist in identifying areas of concern. Afterward, you’ll have the opportunity to meet with our treatment coordinator to review your proposed dental treatment plan.
Please note: Patients under the age of 18 must be accompanied by a parent or guardian during all appointments.
What to Bring
- Referral slip (from your referring dentist)
- X-rays (from your referring dentist)
- List of medications (Please list all medications you are currently taking, or fill out the Medical and Dental History form below)
- Dental insurance card (if any)
Important note: Please notify the office prior to treatment if you have a medical condition or concern such as artificial heart valves or joints, heart murmurs requiring pre-medication, severe diabetes, or hypertension.
We are committed to providing the highest standard of care that is affordable for all patients. Your itemized dental treatment plan will include all applicable treatment fees and we will let you know all costs up front, prior to performing treatment. Payment is required at the time services are rendered.
A member of our team will review payment options with you to determine what best accommodates your financial needs. Dental treatment is an excellent investment in an individual’s health and well-being. Because of this, we believe financial considerations should not be an obstacle to obtaining services. We accept American Express, Discover, MasterCard, Visa, cash, and checks. If you are in need of an extended payment option, we offer 12-month interest-free financing through CareCredit.
Your estimated patient portion is due at the time treatment is rendered. As a courtesy to our patients, we will submit a claim for services rendered to your dental insurance carrier. Outstanding insurance balances over 60 days will become the responsibility of the patient.
Please print and complete each of the forms below prior to your initial visit to our office.
Patient Registration Form
Medical and Dental History Form
Insurance and Financial Policy Form
HIPAA Privacy Practices
HIPAA Notice of Privacy Practices
Technical note: Adobe Acrobat Reader is required to view and print these forms. Download a free copy of Acrobat Reader from the Adobe® website.