New Online Patient Forms

Thank you for your interest in Pleasant Hill Dental. Please fill out and print the following New Patient Form.

New Patient Form Privacy Practices


Appointment Cancellation Policy Form

Please fill out our appointment cancellation policy form before your first visit with us.

Appointment Cancellation Form


Patient Financing Options

We are pleased to offer our patients dental financing options from LendingClub and CareCredit.

Lending Club - Dental Patient Solutions CareCredit