Pacific Dental Excellence

Call Us:  +1.8059296814

Want Us To Bill Your Medical Insurance?

Please Complete the relevant forms below

(Benefits may require you to get a referral from your primary doctor) 

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Other Links:

Patient Forms

New Patients Please Print and Complete all Current Forms Prior to Your Appointment  

           It's Easy! Just Click on the form you need & A new window will open the PDF

Existing patient please refer to forms for the most up to date office policies. 

New Patient Registration Form (Page 1)
New Patient Registration Form (Page 2)

Office Policies

HIPPA (Privacy Policy)

General Consent for Treatment

​ Our office reserves the right to make changes without notice. 2014 Pacific Holistic Dental Inc.
Interested In A Payment Plan?

We work with two companies to give our patients monthly payments that fit most any budget!

*Click on logo to be take to application of your choice

Lending Club Patient FinancingSM

Our practice is pleased to offer flexible payment plans from Lending Club Patient Financing.

  • No initial payment and no payment for 3-7 weeks
  • Affordable Extended Plans with low fixed rates & low monthly payments
  • 6-24 month Promotional Plans
  • No prepayment penalty

You can calculate potential monthly payment options. Or place an application in a few short minutes, and decisions are typically available in seconds. For more information, just ask our team or visit