New Patients

 

Thank you for choosing The Pediatric Dentists to be your child’s dental care provider! Please fill out the following forms before your child’s first scheduled dental appointment.

Pediatric Dentistry Health History
Contact Information and Financial Responsibility
Payment Method / Dental Insurance Policy
– Notice of Privacy –
Acknowledgment of Receipt of Notice of Privacy Acts
Authorization for Agent to Consent to Dental Treatment of a Minor*
*The consent form only needs to be completed if someone other than a legal parent/guardian is bringing them to ANY type of appointment

 

Referring Providers

 

Office Referral Form

Office Referral Form – Printable Version

 

Contact Us

490 S. Farrell Dr., Ste C-101, Palm Springs, CA, 92262
(760) 320-7621

7144 Airway Ave., Yucca Valley, CA 92284
(760) 365-4400

Insurance Plans

We accept most insurance plans and will gladly process your claim. Please bring the necessary information with you on your first visit.

For your convenience, we also accept payments made with your Visa, MasterCard, and Discover.

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Financing Options

Financing is 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.

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