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Forms that make your initial visit a little easier

The first visit to our office is designed to get you better acquainted with all we offer as well as introduce you to Dr. Heckler and our caring staff. We encourage questions and do our best to always deliver quality care. Please take a moment prior to your scheduled appointment to download our patient forms. We ask that you complete the forms and bring them with you to your appointment so we may better assist you in a timely manner. Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.

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    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    Scientists estimate that laughing 100 times is equivalent to a 10-minute workout on a rowing machine.

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    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    Quick naps not only improve your alertness, but they also help in decision making, creativity and sensory perception.

    Lorem ipsum dolor sit amet 3

    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    Scientists estimate that laughing 100 times is equivalent to a 10-minute workout on a rowing machine.

    Lorem ipsum dolor sit amet 4

    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    Scientists estimate that laughing 100 times is equivalent to a 10-minute workout on a rowing machine.

    Lorem ipsum dolor sit amet 5

    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    Quick naps not only improve your alertness, but they also help in decision making, creativity and sensory perception.

    Lorem ipsum dolor sit amet 6

    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    Scientists estimate that laughing 100 times is equivalent to a 10-minute workout on a rowing machine.

    Lorem ipsum dolor sit amet 7

    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    An average heart beats 100,000 times a day, pumping some 2,000 gallons of blood through its chambers. Over a 70-year life span, that adds up to more than 2.5 billion heartbeats.

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    Donec sed odio dui. Nulla vitae elit libero, a pharetra augue. Nullam id dolor id nibh ultricies vehicula ut id elit. Integer posuere erat a ante venenatis dapibus posuere velit aliquet. Duis mollis, est non commodo luctus, nisi erat porttitor.

    Did you know that?

    Scientists estimate that laughing 100 times is equivalent to a 10-minute workout on a rowing machine.

  • Adult Patient Forms

    Please fill this out and bring it in with you
  • Children Patient Forms

    Please fill this out and bring it in with you
  • Financial Policy Information

  • Dental Insurance


    Uncomplicated dental insurance forms
  • Low-Stress Visits


    Easy dental visits for you and the entire family.
  • Got questions?


    Contact us

Heckler Family Dentistry

We look forward to meeting you

  • Peter M. Heckler, D.D.S.
  • 11 Santa Maria
    +925.254.8380
  • Orinda, CA
  • 94563
    hecklerdds@gmail.com
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