2324 Santa Rita Road, Suite 3, Pleasanton, California 94566 • Phone 925 462 4045 • Fax 925 462 8587 • smile@michelechalmersdds.com

Accepting New Patients

925 462 4045

New Patient Forms

You can download the office forms required for registration here, and then, at your convenience, fill out the forms and bring them to the office on your first visit.  This will save you time and prevent errors.  Please be sure to include the medications you take, along with the dosage.  Thank you, Dr. Chalmers. “

New Patient Forms (adult)


New Patient Forms (minor under 18)