Patient Forms and Financial

Pasadena Dental Aesthetics
826 Union St.
Pasadena, CA 91101

Phone: (626) 793-4683
New patients call (855) 768-7333 or request an appointment using our form below.

Office Hours

Monday & Friday: 9:00am am – 3:00 pm
Tuesday-Thursday: 9:00 am – 6:00 pm
Saturday: By Appointment (Limited Dates)

New Patient Forms

If you are new to our office, we’ve provided patient forms for you to complete prior to arriving for your first visit. For your convenience, our patient registration forms are available for you to fill out online in our secure patient portal below:

• Adult Forms
• Child Forms

Office Tour

A map to our location

Financial Arrangements

We accept many major dental insurance plans. We file your claims for you, and your estimated portion is due at the time of service. View the list of dental insurance companies for which Dr. Arash Azarbal, our experienced dentist, is an in-network preferred provider.

Dr. Azarbal is an in-network, preferred provider for the plans listed below.

We accept the contracted fees from these insurance companies and will file your dental claims with your insurance provider. You are not responsible for the amount above what the plan allows, but you are responsible for your portion of the contracted fees at the time of service.

• Aetna
• Ameritas
• Anthem Blue Cross
• Assurance
• Blue Shield
• Cigna Dentist
• Connection Dental
• Delta Dental
• Dental Benefit Providers
• First Dental Health
• Guardian
• Humana
• MetLife
• Principal
• United Concordia

In addition to dental insurance, we accept Visa^®, MasterCard^®, and American Express. Payment plans and financing are also available if you would prefer to pay for your services over time. We participate in CareCredit^®, through which no-interest payment plans are available, Citi^® Health Card, SimplePay™ and Lending Club.

Unless other arrangements have been made in advance, payment is required at the time of your visit.

To learn more about the lending institutions we work with, please review the information below. If you have additional questions about payment plans, financing options, or the cost of services, please contact our office today.

CareCredit^®

Designed exclusively for healthcare services, CareCredit^®, a division of GE Money™, offers a number of affordable payment options with low interest rates for qualified applicants. They have helped over seven millions members receive the treatments they want and need.

LendingClub^®

LendingClub^®, one of the most well known and highest recommended lending agencies, makes the dental financing process quick and simple. Short and long term plans, low cost monthly installments, and low or no-interest options make customization uncomplicated. Click the link below to learn more about our payment plan options available.