Piedmont Dental By Design Piedmont Dental By Design

New Patient Info

If you are a new patient, or an existing patient who needs to update your information Please click on the "Patient Forms" tab below.  

*No need to print out the forms as they will automatically upload into our system. 

*If you are a new patient who has never been into our office before, we ask that you fill out your forms online prior to your appointment. Filling them out online will allow us to attend to your medical needs more quickly than completing them on your arrival.  If you cannot fill out your forms online, please arrive 10 minutes prior to your appointment, and we will have you fill them out in office on our iPAD. 

Thank you and please call our office at (510) 652-2911 if you have any questions at all.

Patient Forms

Payment Options

For your convenience, we accept cash, personal checks, money orders, Care Credit and major credit cards. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.


As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network. We are not part of any managed care network. Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be.

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months.

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Piedmont Dentists, Dr Jill Martenson is a dental professional dedicated to General, Family & Cosmetic Dentistry with services including Dental Exams, Dental Makeovers, Teeth Whitening, Veneers, Crowns, X-rays, Fluoride, Cleanings, & more. Please come and visit Piedmont Dental by Design in Piedmont, CA today.

Jill Martenson, DDS 2021

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