Forms & Financials

Detailed financial information and new patient forms

New Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

If you’re unable to open PDF files, you can get Adobe Reader® for free.

Ready to make an appointment?

Financial Information

The cost of your orthodontic treatment may be different than others depending on your individual needs and treatment plan. Dr. Silvana Gonzalez and her team will discuss with you the cost of your treatment and your available payment plan options.

We understand that orthodontic treatment is a sizable investment. That’s why we we will work with you to create a payment plan that fits your budget. From our free consultation to our affordable payment plans for your braces, there’s many ways to get a healthier smile without having to worry about the cost.

No Down Payment, Interest-free Payment Plans

We offer:

  • Interest-free financial payment plans throughout treatment with no down payment
  • Low monthly payments that are always interest free
  • Automatic credit card or bank draft payments through OrthoBanc
  • Discounts for those who pay in full

Does your employer offer a flexible spending plan? If so, we can contribute these pretax dollars towards your orthodontic expenses!

Your smile is yours forever, and we want to make it as easy as possible for you to receive the best orthodontic care whenever you need it.

** Our practice accepts most major credit cards and insurance plans. **

Insurance Information

Our office staff is always available to help you with insurance claims and paperwork, if you have insurance that will be covering any portion of your orthodontic treatment.

Please let us know if you have any questions about your insurance coverage and how we can help to make your entire orthodontic experience a pleasant one.

Convenient Online Services

With just the simple click of a mouse, our secure online service allows you to:

  • View your appointment and account information any time
  • Sign up for email or text appointment reminders
  • Check your payment history and see current charges
  • Print out flex spending reimbursement and tax receipts

If you do not have a patient log in and would like to begin viewing your account information online, please click here to sign up for your own personal account.