top of page

Search Results

9 items found for ""

  • ABOUT DR. LE | SCM Dentistry

    HOME ABOUT DR. LE SERVICES DENTAL ADVANTAGE PLAN RESOURCES CONTACT US More Dr. Brandon Le Meet Dr. Le earned his undergraduate degree in biology at the University of California, San Diego, close to his hometown in Irvine. He then went on to earn his Doctor of Dental Medicine degree at Midwestern University in Arizona. Dr. Le was introduced to his first hands-on exposure to dentistry through a merit badge with his Boy Scout troop. His positive experience learning from great leaders led way to volunteering in healthcare clinics and attending dental humanitarian missions abroad in Vietnam and Nuku Alofa, Tonga. He went on to lead his troop for three years after earning his Eagle Scout rank. His focus on aesthetics, which influences much of his works of art in the office, is what drives him to create the best outcome for his patients who may be seeking that artisan touch combined with the knowledge of the most up-to-date technology in the field of dentistry. It is his absolute passion to make comfortability and forming relationships his priority in dentistry. In his free time, Dr. Le enjoys spending time with his family, surfing, oil painting, teaching piano, woodworking, and spending time with his Australian Shepherd named Remy. Memberships and Affiliations ​ ​ American Dental Association (ADA) California Dental Association (CDA) Academy of Laser Dentistry (ALD) Frank Spear Continuing Education Member

  • Patient Forms (2/2) | SCM Dentistry

    New Patient Information (Form 2 of 2)​​ Medical History Your Name (Last, First, Middle) Physician's Name Address Phone Email Date of Last Visit Have you had any serious illnesses or operations? No Yes If yes, please describe: Have you ever had a blood transfusion? No Yes If yes, give approximate date(s): Do you or have you ever taken bisphosphonate medications for osteoperosis, cancer, or multiple myeloma (such as Fosamax, Actonel, Boniva, Reclast, Aredia, or Zometa)? No Yes Are you currently under physician care? No Yes If yes, please describe: Are you pregnant or do you think you may be? No Yes Are you nursing? No Yes Are you taking birth control? No Yes If yes, please describe: Select yes if you have or have had the following: AIDS/HIV positive No Yes Anaphylaxis No Yes Anemia No Yes Arthritis No Yes Artificial heart valves No Yes Artficial joints No Yes Asthma No Yes Atopic (allegy prone) No Yes Back problems No Yes Blood disease No Yes Cancer No Yes Chemical dependency No Yes Chemotherapy No Yes Circulatory problems No Yes Cortisone treatments No Yes Cough (peristent) No Yes Coughing up blood No Yes Diabetes No Yes Epilepsy No Yes Fainting No Yes Food allergies No Yes Glaucoma No Yes Headaches No Yes Heart murmur No Yes Heart problems No Yes Hemophilia/abnormal bleeding No Yes Herpes No Yes High blood pressure No Yes Jaw pain No Yes Kidney disease or malfunction No Yes Liver disease No Yes Material allergies (latex, wool, metal, chemicals) No Yes Mitral valve prolapse No Yes Nervous problems No Yes Pacemaker / heart surgery No Yes Psychiatric care No Yes Rapid weight gain or loss No Yes Radiation treatment No Yes Repiratory disease No Yes Rheumatic fever No Yes Scarlet fever No Yes Shingles No Yes Shortness of breath No Yes Skin rash No Yes Spina bifida No Yes Stroke No Yes Surgical implant No Yes Swelling of feet or ankles No Yes Thyroid disease or malfunction No Yes Tobacco habit No Yes Tonsilitis No Yes Tuberculosis No Yes Ulcer/colitis No Yes Venereal disease No Yes Hepatitis No Yes Are you allergic to any of the following? Aspirin Cephalexin Clindamycin Codeine/Hydrocodone Ibuprofen/NSAIDs Penicillin Sulfa None of the above Other If other, please specify: List any medications you are currently taking, if any: Authorization I have reviewed the information on this questionnaire and it is accurate to the best of my knowledge. I understand that this information will be used by the dentist to help determine appropriate and healthful dental treatment. If there is any change in my medical status, I will inform the dentist. Authorization Signature Clear Print Name Date Submit (Form 2 of 2) ​ Please wait while the form submits. You will be automatically redirected.

  • Smile Gallery | SCM Dentistry

    Smile Gallery We love seeing our patients' happy and healthy smiles!

  • Patient Forms | SCM Dentistry

    New Patient Forms Welcome to South Coast Metro Center for Dentistry & Implants. Before your first visit to our office, please take a few minutes to fill out the necessary forms before your scheduled appointment. If you would prefer to print out the forms, click the button below to download a PDF and bring the forms to your first visit. New Patient Forms New Patient Inform ation (Form 1 of 2) Name (Last, First, Middle) Date of Birth Address Sex F M Social Security Number City State ZIP Phone Email Whom may we thank for referring you? Emergency Contact Information Name of Emergency Contact Phone Relationship Email Primary Insurance Information Dental Insurance Carrier Group Number Subscriber ID Account Holder Name (Last, First, Middle) Relationship to Patient Social Security Number Date of Birth Address (if different from patient) Phone City State ZIP Email Dental History What is the main reason for your visit? Are you in any dental discomfort? Former Dentist Address Phone Date of Last Dental Care Date of Last X-rays Email Select yes if you have any of the following: Bad breath No Yes Food collection between teeth No Yes Periodontal treatment No Yes Sensitivity to sweets No Yes Bleeding gums No Yes Grinding or clenching teeth No Yes Sensitivity to cold No Yes Sensitivity when biting No Yes Clicking or popping jaw No Yes Loose teeth or broken fillings No Yes Sensitivity to heat No Yes Sores or growths in mouth No Yes Pain that wakes you up at night No Yes How often do you brush? Have you ever experienced an adverse reaction during or in conjuction with a medical or dental procedure? No Yes How often do you floss? If yes, please describe: How do you feel about the appearance of your teeth? HIPAA Consent Our Notice of Privacy Practices provides information about how we may use and disclose protected health information about you. The Notice also contains a patient rights section describing your patient rights under the law. You have a right to review this notice before signing the consent. The terms of the notice may change, and if this should occur, you may receive a revised copy by contacting the office. You have the right to restrict how protected health information about you is used or disclosed for treatment, payment or healthcare operations. We are not required to agree to this restriction, but if you do, we shall honor that agreement. By signing this form, you consent to our use and disclosure of protected health information about you for the treatment, payment or healthcare operations via telephone, mail, fax, electronic mail, and verbal communications. You have a right to revoke this consent in writing, signed by you. However, such a revocation shall not affect any disclosures we have already made in relation to you on your prior consent. The practice provides this form to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The patient understands that: 1. Protected health information may be disclosed or used for treatment, payment or health care operations. ​ 2. The practice has a Notice of Privacy Practices and the patient has the opportunity to review this notice. ​ 3. The practice reserves the right to change the notice of privacy practices. ​ 4. The patient has the right to request restricted use of their information, but the practice does not have to agree to those restrictions. ​ 5. The patient may revoke this consent in writing at any time and all future disclosures will then cease. HIPAA Consent Signature Clear Print Name Date Financial Policy Thank you for selecting South Coast Metro Center for Dentistry & Implants as your dental care provider. Our primary mission is to deliver the best and most comprehensive dental care available. An important part of the mission is making the cost of optimal care as easy and manageable for our patients as possible by offering several payment options. For patients without dental insurance, full payment is required at time of treatment unless we have authorized a different payment plan. For patients with dental insurance we will work with our carrier to maximize your benefits and directly bill them for reimbursement for your treatment. Not all services are covered benefits by your insurances. Your insurance policy is a contract between you and the insurance company. Our financial relationship is with you and not the insurance company. All charges are your responsibility whether your insurance company pays or not. All of the information we provide regarding your insurance benefits are only estimates. Fees for services, including deductibles, co-payments, and services and procedures not covered or denied under your insurance plan are due at the time of treatment. If the insurance company does not pay your covered benefits within 30 days, we will ask that you contact the insurance carrier to expedite the payment process ​ If the insurance company does not pay your balance within 45 days, we will require that you pay the balance due. Balances older than 90 days are considered to be in delinquency and will be reported to the credit bureau and sent to collections. All fees associated with collection on your account will be your responsibility, including but not limited to collection agency fees in addition to the balance owed. A monthly 1.5% interest fee will be charged on account balances over 90 days. ​ Our office offers the following payment options: • Cash, Check, Visa, Mastercard, American Express • Payment Plans from CareCredit and Lending Club Please note: We request 24 hour prior notice of any cancellations otherwise a $50 cancellation fee will be charged. Our office charges $30 for returned checks. If you have any questions, please do not hesitate to ask. Financial Policy Signature Clear Print Name Date General Consent 1. Work to be done: As a new patient, I understand that I am having an exam and x-rays taken. Initials 2. Drugs and medications: I understand that antibiotics, analgesics and other medications may cause allergic reactions causing redness and swelling of tissue, pain, itching, vomiting, and/or anaphylactic shock. I have advised my dentist of any and all medications I am currently taking, including but not limited to prescription medications, over-the-counter medications, herbal remedies, and alternative medications. I further understand that failure to advise my dentist of any medications I am taking prior to starting dental work may have unforeseen negative consequences for me. ​ Initials 3. Photo authorization: I consent to photography, filming, recording, and x-rays of my oral structures as related to my dental procedures and for their educational use, provided that my identity is not revealed. Initials Initials 4. I understand that dentistry is an inexact science and that therefore, reputable practitioners cannot properly guarantee results. I acknowledge that no guarantee or assurance has been made to me by anyone regarding the dental treatment(s) which I have requested and authorized. ​ I hereby authorize any of the doctors or dental assistants or auxiliaries to proceed with and perform the dental restorations and treatments indicated above and as explained to me. I understand that this is only an estimate and subject to modification depending on unforeseen or undiagnosed circumstances that may arise during the course of treatment. I understand that regardless of any dental insurance coverage I may have, I may be responsible for payment of the dental fees. General Consent Signature Clear Print Name Date Submit (Form 1 of 2) ​ Please wait while the form submits. You will be automatically redirected to the second form. (This may take a few minutes).

  • SERVICES | SCM Dentistry

    Our Services Creating beautiful, healthy smiles REQUEST A VISIT CALL (714) 942-2447 Preventative Care Exams & cleanings Oral cancer screenings Laser treatments Occlusal guards Restorative Dentistry Fillings Crowns & bridges Full & partial dentures Periodontal treatments Root canal treatments Extractions/grafts Implant restorations, including All-On-X Cosmetic Dentistry Veneers Teeth whitening Clear Aligners Invisalign® OrthoFX®

  • DENTAL ADVANTAGE PLAN | SCM Dentistry

    Dental Advantage Plan $359 per person / year We're dedicated to providing quality and affordable care for all of our patients. We offer an in-house dental plan, which has no initiation fee, pre-approvals, deductibles, annual maximums, monthly premiums, or waiting period. ​ The Dental Advantage Plan includes: 1 comprehensive exam 1 periodic exam 1 emergency exam Full mouth X-rays 2 regular cleanings Up to 20% discount off all other treatment ​ Coverage lasts for 12 consecutive months and begins when payment is made in full. This discount plan is only available to patients who do not have dental insurance.

  • South Coast Metro Center for Dentistry and Implants | Santa Ana, CA

    Find Your Smile, Brighten Your World REQUEST A VISIT Welcome to Our Practice At South Coast Metro Center for Dentistry & Implants, our team is dedicated to providing quality dental care in a welcoming and relaxed setting. Conveniently located in the heart of Orange County, our practice utilizes state-of-the-art technology. Our doctors of dentistry offer a full range of general and cosmetic dental services. Together, we can help you "Find Your Smile, Brighten Your World!" Testimonials Our Services Creating beautiful, healthy smiles REQUEST A VISIT CALL (714) 942-2447 Preventative Care Exams & cleanings Oral cancer screenings Laser treatments Occlusal guards Restorative Dentistry Fillings Crowns & bridges Full & partial dentures Periodontal treatments Root canal treatments Extractions/grafts Implant restorations, including All-On-X Cosmetic Dentistry Veneers Teeth whitening Clear Aligners Invisalign® OrthoFX® The Patient Experience We are committed to quality, transparency, and excellent patient care. Thank you for your continued support! Metzli U. "This is, by far, one of the best dentistry offices I have been to. I had always been hesitant to go back to a dentist office after a bad experience. I came with an open mind and they have never disappointed. The entire staff is so helpful, kind and understanding." Home Welcome Untitled Gallery Our Services Testimonials

bottom of page