David M. Kang DDS, Carol K. Yeung DDS 1770 East Lambert Road Suite 210, Brea, California, 92821 714-255-8338, 714-255-1326
David M. Kang DDS, Carol K. Yeung DDS
1770 East Lambert Road Suite 210, Brea, California, 92821
714-255-8338, 714-255-1326
I authorize my insurance company to pay Brea Pediatric Dental Practice all insurance benefits otherwise payable to me for services rendered. I also authorize the use of this signature on all insurance submissions. I understand that I am financially responsible for all charges for services rendered whether or not it is covered by my insurance and that all payments are due when services are rendered. I also understand that obtaining insurance coverage and benefit information is my responsibility and not the responsibility of Brea Pediatric Dental Practice. This consent is to remain in effect until canceled in writing.
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