New Patients

Patient Forms

Before your first visit with Dr. Li, please complete your new patient forms, found below. Your visit to the dentist should be focused on your smile, not on paperwork. Click the links to download your forms and print them out. Complete them and do not forget to bring them with you! If you need help, please do not hesitate to call us at Belmar Smiles in Lakewood, Colorado. We look forward to meeting you and your family and providing you with excellent dental care.

New Patient Form Financial/Cancellation Policy Notice of Privacy Practices Acknowledge Receipt HIPPA

All forms are in Abobe PDF format. If you don’t already have Adobe Acrobat Reader you can download it free by following this link.

At Belmar Smiles, we are pleased to offer multiple payment options to help meet any financial situation. We accept most dental insurances and have comprehensive information available in our office for you to review about our insurance policies. At this time, we also accept cash, check, credit cards, and CareCredit. CareCredit is a third-party financing company that offers low monthly payments. More information can be found at CareCredit’s website by clicking on the link below.

If you have questions about your financial options, we encourage you to contact our friendly dental office in Lakewood, Colorado. Each member of our team is dedicated to helping you in any way we can. We hope to hear from you soon!

carecredit

Appointments

We will do our best to accommodate your busy schedule. Request an appointment today!

Please use this form for general information purposes only. DO NOT send personal health information through this form. Specific patient care must be addressed during your appointment.