New Patient Forms
Thank you for choosing Dr. Gutenberg and Associates Pediatric Dentistry to be your child’s dental care provider! Please complete the following forms prior to your child’s/children’s first scheduled dental appointment.
*One form is required per child.
**Consent form only needs to be completed if someone other than the legal parent/guardian is bringing the child/children to ANY type of dental appointment.
Returning Patient Forms
We kindly ask that all returning patients please complete this informational update form prior to every six month examination appointment. One form is required per child.
Referring Provider Forms
We kindly ask that all referring providers please complete this form digitally prior to referring patients to Dr. Gutenberg and Associates Pediatric Dentistry. This form aids our office in understanding the dental needs of the patient and what the referring provider is requesting we evaluate.
Dr. Gutenberg and Associates Pediatric Dentistry gladly accepts most insurances. We are also happy to provide services to those that are uninsured, underinsured, or have insurance that is out-of-network with our offices. Call Dr. Gutenberg and Associates Pediatric Dentistry today for details.
Financing is also available through CareCredit. With CareCredit, you pay no up-front costs, no pre-payment penalties and no fees. Plus, CareCredit is a revolving credit line for additional care or add-on charges, without the need to re-apply. Use CareCredit’s Payment Calculator to compare plans and get an estimate of what your monthly payment will be.
It only takes a few minutes to apply for CareCredit and you may receive an online decision in seconds! Apply now or see our staff for more details.
Palm Springs Location
490 S. Farrell Drive, Suite C-101
Palm Springs, CA, 92262
Yucca Valley Location
7144 Airway Avenue,
Yucca Valley, CA 92284