form download/submission
New Patient Forms
Download and unzip the forms, fill out via your computer, and email the finished forms to newpatient@eurekadental.com
form download/submission
discount/payment-plan
Payment Options
- Payment in full. We offer a discount on all payments, via cash, check or credit card paid in full. - No- or low- interest payment plans including a zero down payment for most cases. - Post benefit verification, estimated co-payment at time of service payable by cash, check or credit card. - An in-house dental plan offered at excellent rates (subject to credit approval). Begin an application now by clicking here. - CareCredit® payment option. To apply, go to the CareCredit website and choose the Apply Now button to start the approval process or click here to download the PDF form to print and fill out. - Insurance claims processed at no additional charge for any option.
discount/payment-plan